Published in:
01-12-2018 | Cancer Anesthesia (B Riedel and V Gottumukkala, Section
Editors)
Transfusion Therapy: Is There a Link with Cancer
Recurrence?
Authors:
Ruben D. Agudelo-Jimenez, Juliana A. Heatter, Juan P. Cata
Published in:
Current Anesthesiology Reports
|
Issue 4/2018
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Abstract
Purpose of Review
To present an updated narrative review of the available clinical
evidence regarding the impact of perioperative anemia and blood product
administration on cancer recurrence and mortality. To address some of the
current strategies to reduce blood transfusions and their safety in oncologic
surgery.
Recent Findings
Both anemia and packed red blood cells (pRBCs) transfusions have
been associated with an increased risk of recurrence and mortality in certain
solid malignancies. Anemia directly stimulates protective mechanisms against
apoptosis of cancer cells while promoting a favorable micro-environment and
reducing the efficacy of anticancer therapies. When transfusion occurs,
transfusion-related immunomodulation (TRIM) mediates the immunosuppression and
inflammation responsible for the impairment of the host immune system to
appropriately eliminate cancer cells. However, pRBCs can also promote tumor
growth by non-TRIM mechanisms.
Summary
Evidence of the negative impact of perioperative anemia and blood
transfusions on cancer recurrence and mortality should raise concern about the
appropriate timing of blood transfusions in patients with cancer undergoing
surgical procedures. Blood sparing strategies such as acute normovolemic
hemodilution, autologous pRBCs transfusions and intraoperative cell savage
appear to be safe means to minimize allogeneic pRBCs in the context of cancer
surgery, although the safety of these strategies has not been rigorously tested
in randomized controlled trials.