Blood Transfusions, Thrombosis, and Mortality in Hospitalized Patients With Cancer

Abstract

Background: Anemia is frequent in patients with cancer, but there are concerns regarding treatment with erythropoiesis-stimulating agents. Blood transfusions are commonly used as an alternative, but with little data regarding outcomes.Methods: In a retrospective cohort study, we investigated the associations between transfusions and venous thromboembolism, arterial thromboembolism, and mortality in hospitalized patients with cancer using the discharge database of the University HealthSystem Consortium, which included 504 208 hospitalizations of patients with cancer between 1995 and 2003 at 60 US medical centers.Results: Of the patients included, 70 542 (14.0%) received at least 1 red blood cell (RBC) transfusion and 15 237 (3.0%) received at least 1 platelet transfusion. Of patients receiving RBC transfusions, 7.2% developed venous thromboembolism and 5.2% developed arterial thromboembolism, and this was significantly greater than the rates of 3.8% and 3.1%, respectively, for the remaining study population (P Ͻ.001). In multivariate analysis, RBC transfusion (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.53-1.67) and platelet transfusion (1.20; 1.11-1.29) were independently associated with an increased risk of venous thromboembolism. Both RBC transfusion (OR, 1.53; 95% CI, 1.46-1.61) and platelet transfusion (1.55; 1.40-1.71) were also associated with arterial thromboembolism (P Ͻ.001 for each). Transfusions were also associated with an increased risk of inhospital mortality (RBCs: OR, 1.34; 95% CI, 1.29-1.38; platelets: 2.40; 2.27-2.52; PϽ .001).Conclusions: Both RBC and platelet transfusions are associated with increased risks of venous and arterial thrombotic events and mortality in hospitalized patients with cancer. Further investigation is necessary to determine whether this relationship is causal.

Prevalence of Anemia and Iron Deficiency in Romanian Patients with Inflammatory Bowel Disease: a Prospective Multicenter Study

“…Intravenous iron substitution is recommended for patients that require rapid hemoglobin correction, for cases of severe anemia and for those that are taking erythropoiesis stimulating agents (ESA). Blood transfusions may increase the risk for arterial and venous thromboembolic events [21], a risk that is already higher than in the general population because of the chronic inflammatory process and the activated cytokines. Transfusions can also lead to immunomodulation and infections [22][23][24].…”

Death as a Drug Side Effect in FAERS: Is Glyphosate Contamination a Factor?

“…Lum and Gambino found extremely high levels of GGT in cases of acute pancreatitis, primary carcinoma of the head of the pancreas, and adenocarcinoma of the bile duct [113]. GGT levels were higher than the upper limit of normal for 100% of cases of pancreatitis, with an average value of ten times the upper limit.A retrospective study on over half a million hospitalized cancer patients, between 1995 and 2003, showed that the administration of both red blood cells and platelets led to increased risk to thrombosis and death compared to no transfusion [116]. It was proposed that a factor could be the presence of redox-active iron in the transfusion, leading to an increase in iron-catalyzed free radical-mediated oxidative stress [117].…”

Assessment and treatment of preoperative anemia: Continuing Professional Development

“…Multiple studies have shown an association of allogeneic blood transfusion with postoperative infections, prolonged hospital stay, and morbidity and mortality. [13][14][15][16][17]43 Moreover, allogeneic blood transfusion has been associated with increased risk of thrombotic events 45 and decreased disease-free survival in cancer patients. 46 In fact, in a systematic review completed by Marik et al, the risks of transfusion were found to outweigh the benefits in 42 out of 45 of the studies evaluated.…”