Watkins Thomas, Surowiecka Maria Katarzyna, McCullough Jeffrey
Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, 55455, USA.
Cancer Control. 2015 Jan;22(1):38-46. doi: 10.1177/107327481502200106.
During the last few years, considerable focus has been given to the management of anemia and coagulopathies. This article provides current concepts of red blood cell (RBC) and plasma coagulation factor replacements.
The literature was reviewed for clinical studies relevant to RBC transfusion indications and outcomes as well as for the uses of coagulation factor replacement products for coagulopathies most likely encountered in patients with cancer.
Most patients without complications can be treated with a hemoglobin level of 7 g/dL as an indication for RBC transfusion. However, the effects of disease among patients with cancer may cause fatigue, so transfusions at higher hemoglobin levels may be clinically helpful. Leukoreduced RBCs are recommended as standard therapy for all patients with cancer, most of whom do not develop coagulopathy. Transfusions to correct mild abnormalities are not indicated in this patient population. Data are inconclusive regarding the value of coagulation factor replacement for invasive procedures when the international normalized ratio is below 2.
Indications for RBC transfusion have become more conservative as data and experience have shown that patients can be safely and effectively maintained at lower hemoglobin levels. Coagulation factor replacement is unnecessary for most modest coagulopathies.
在过去几年中，贫血和凝血病的管理受到了相当大的关注。本文提供了红细胞（RBC）和血浆凝血因子替代治疗的当前概念。
对与RBC输血指征和结果相关的临床研究以及癌症患者最可能出现的凝血病的凝血因子替代产品的使用情况进行了文献综述。
大多数无并发症的患者血红蛋白水平为7 g/dL时可作为RBC输血的指征进行治疗。然而，癌症患者的疾病影响可能导致疲劳，因此较高血红蛋白水平的输血在临床上可能有帮助。推荐白细胞滤除的RBC作为所有癌症患者的标准治疗，其中大多数患者不会发生凝血病。该患者群体中不建议进行输血以纠正轻度异常。当国际标准化比值低于2时，凝血因子替代治疗侵入性操作的价值尚无定论。
随着数据和经验表明患者可以在较低血红蛋白水平下安全有效地维持，RBC输血指征变得更加保守。对于大多数轻度凝血病，无需进行凝血因子替代治疗。
