New Guidelines on Anaemia Management in Patients with Cancer: How Do These Affect Clinical Practice?

Restrictive blood transfusion protocol in malignant upper gastrointestinal and pancreatic resections patients reduces blood transfusions with no increase in patient morbidity

BACKGROUND

The purpose of this study was to determine the impact of a restrictive blood transfusion protocol on the number of transfusions performed and the related effect on patient morbidity.

METHODS

A cohort study was performed using our prospective database with information from January 1, 2000, to June 1, 2013. The restrictive blood transfusion protocol was implemented in September 2011, so this date served as the separation point for the date of operation criteria.

RESULTS

For the study, 415 patients undergoing operation for an abdominal malignancy were reviewed. After the restrictive blood transfusion protocol, the percentage of patients who received blood dropped from 35.6% to 28.3%. The percentage of patients who experienced perioperative complication was significantly higher in transfused patients compared with those who did not receive blood (P = .0001). There was no statistical significance observed between the 5 groups for the length of stay at the hospital after their procedure.

CONCLUSIONS

The restrictive blood transfusion protocol resulted in a reduction of the percentage of patients transfused, and there was no evidence to suggest that it negatively affected the outcomes of patients in this group.

Restrictive blood transfusion protocol in liver resection patients reduces blood transfusions with no increase in patient morbidity

BACKGROUND

Management of anemia in surgical oncology patients remains one of the key quality components in overall care and cost. Continued reports demonstrate the effects of hospital transfusion, which has been demonstrated to lead to a longer length of stay, more complications, and possibly worse overall oncologic outcomes. The hypothesis for this study was that a dedicated restrictive transfusion protocol in patients undergoing hepatectomy would lead to less overall blood transfusion with no increase in overall morbidity.

METHODS

A cohort study was performed using our prospective database from January 2000 to June 2013. September 2011 served as the separation point for the date of operation criteria because this marked the implementation of more restrictive blood transfusion guidelines.

RESULTS

A total of 186 patients undergoing liver resection were reviewed. The restrictive blood transfusion guidelines reduced the percentage of patients that received blood from 31.0% before January 9, 2011 to 23.3% after this date (P = .03). The liver procedure that was most consistently associated with higher levels of transfusion was a right lobectomy (16%). Prior surgery and endoscopic stent were the 2 preoperative interventions associated with receiving blood. Patients who received blood before and after the restrictive period had similar predictive factors: major hepatectomies, higher intraoperative blood loss, lower preoperative hemoglobin level, older age, prior systemic chemotherapy, and lower preoperative nutritional parameters (all P < .05). Patients who received blood did not have worse overall progression-free survival or overall survival.

CONCLUSIONS

A restrictive blood transfusion protocol reduces the incidence of blood transfusions and the number of packed red blood cells transfused. Patients who require blood have similar preoperative and intraoperative factors that cannot be mitigated in oncology patients. Restrictive use of blood transfusions can reduce cost and does adversely affect patients undergoing liver resection.

Blood transfusion and cancer surgery outcomes: a continued reason for concern

BACKGROUND

The adverse effects of blood transfusion after cancer surgery have been recently challenged in older anemic persons or those with substantial intraoperative blood loss. We hypothesized that intraoperative blood transfusions continue to adversely impact short-term cancer surgery outcomes regardless of age or preoperative hematocrit levels.

METHODS

Using the 2005 to 2008 American College of Surgeons National Surgical Quality Improvement Program, we identified 38,926 patients who underwent cancer surgery. Pre-, intra-, and postoperative factors were compared by units of blood transfusion a patient received. Stratified multivariable analyses, by age and hematocrit level, were performed to assess the impact of blood transfusion on operative outcomes, adjusting for covariates.

RESULTS

Fourteen percent of patients received an intraoperative blood transfusion. Of those, >60% received only 1 to 2 units of blood. Receipt of intraoperative blood transfusion was associated with higher rates of 30-day operative mortality, major complications, total number of complications, and prolonged length of stay across age groups and in persons with low to normal hematocrit levels.

CONCLUSION

The present study shows that intraoperative blood transfusion adversely impacts short-term operative cancer surgery outcomes across all age groups and in those with low to normal hematocrit levels. These findings provide insightful implications on the patterns of blood transfusion during cancer surgery that deserve further investigation.

Allogeneic blood transfusion given before radiotherapy is associated with the poor clinical outcome in patients with cervical cancer

PURPOSE

To analyze the effect of allogeneic blood transfusion on clinical outcome in 119 patients with stage IIB cervical cancer who were treated with radiotherapy +/- chemotherapy.

PATIENTS AND METHODS

Medical records were examined for hemoglobin levels before and during radiotherapy, history of allogeneic blood transfusions and the time point when transfusions were given. These factors were retrospectively analyzed along with other clinical risk factors for influences on the patients' clinical outcomes.

RESULTS

Thirty-two patients (26.9%) received packed red blood cell transfusion (mean, 3.4 units; range, 1-12 units) before or during radiotherapy. Median follow-up period was 39.3 months (range, 7.6-58.4 months). Patients with history of transfusion showed poorer metastasis-free survival and a trend toward poorer overall survival than non-transfused patients. When patients who received transfusions were sub-divided by the time of transfusion, those who received transfusions before radiotherapy had significantly poorer clinical outcome than those who received transfusions during radiotherapy. In a multivariable analysis, patients with pretreatment transfusion showed a higher risk of distant metastasis (HR = 3.75, 95% CI: 1.28-12.15, p = 0.017) and decreased overall survival rates (HR = 4.62, 95% CI: 1.15-18.54, p = 0.031) compared with those of other patients.

CONCLUSION

Our results suggest that allogeneic blood transfusions given before radiotherapy may be associated with higher incidence of distant metastases and decreased survival in patients with stage IIB cervical cancer.