Transfusion Requirements in Surgical Oncology Patients

Abstract

A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.

Red Cell Transfusion Triggers and Postoperative Outcomes After Major Surgery

“…5,25 While blood transfusion can be lifesaving for patients experiencing profound anemia by increasing oxygen delivery capacity and tissue perfusion, 10,26 transfusion can result in diminished immune function and other transfusionrelated adverse events such as acute lung injury. 4,8,9,27,28 Although previous randomized clinical trials and recent guidelines suggest that red cell transfusion is usually not indicated above a Hb concentration of 7 or 8 g/dL in a hemodynamically stable patient, the ideal trigger for transfusion Of note, among patients who were transfused, the incidence of complications did increase slightly over the periods examined (P=0.03). Consistent with previous findings, 5,13,16,29-31 we noted that restrictive PRBC transfusion practices did not result in worse risk-adjusted perioperative outcomes compared with a liberal transfusion strategy.…”

“…5 In contrast, a separate study by de Almeida et al demonstrated that patients undergoing abdominal cancer surgery who were transfused liberally had a lower absolute risk of overall complications compared patients transfused with a restrictive strategy. 4 The current study expanded on these previous studies as it examined a large cohort of patients (n>10,000) who underwent either a CT-V or complex GI surgical procedure. Importantly, we noted that the risk of postoperative complications following cardiothoracic, vascular, or complex general surgery cases was not associated with a more restrictive transfusion strategy on multivariable analysis.…”

“…transfusion can also result in a diminished immune response and transfusion-related acute lung injury. 4,[8][9][10] Our group and others have also noted that transfusion can possibly be related to worse long-term oncological outcomes. 11,12 As such, there is an increasing interest in trying to minimize patient exposure to unnecessary transfusions.…”

“…[1][2][3] Specifically, potential blood loss is an inherent risk with long, complicated operations and blood transfusion is common in this setting. [4][5][6] In fact, of the approximately 15 million units annually transfused in the USA, many of these transfusions are for patients undergoing surgical procedures. 7 While blood transfusion can improve oxygen delivery, tissue perfusion can be lifesaving, Electronic supplementary material The online version of this article (doi:10.1007/s11605-015-2926-9) contains supplementary material, which is available to authorized users.…”

“…17,21 In contrast, other investigators have reported that a liberal red cell transfusion strategy was associated with fewer postoperative complications in patients who underwent major cancer surgery. 4 The topic, therefore, remains controversial, as the impact of a liberal versus restrictive transfusion strategy among different patient populations remains ill defined.…”