Shah Neil, Andrews Jennifer, Goodnough Lawrence Tim
Department of Pathology, Stanford University, USA.
Department of Pathology, Stanford University, USA; Department of Pediatrics, Stanford University, USA.
Blood Rev. 2015 Sep;29(5):291-9. doi: 10.1016/j.blre.2015.02.001. Epub 2015 Feb 14.
Anemia is present in over two-thirds of patients with malignant hematological disorders. The etiology of anemia predominates from ineffective erythropoiesis from marrow infiltration, cytokine related suppression, erythropoietin suppression, and vitamin deficiency; ineffective erythropoiesis is further exacerbated by accelerated clearance due to antibody mediated hemolysis and thrombotic microangiopathy. As the anemia is chronic in nature, symptoms are generally well tolerated and often non-specific. Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Conservative/restrictive RBC transfusion practices have shown equivalent patient outcomes compared to liberal transfusion practices, and meta-analysis has shown improved in-hospital mortality, reduced cardiac events, re-bleeding, and bacterial infections. The implications for a lower threshold for transfusion in patients with malignancies are therefore increasingly being scrutinized. Alternative management strategies for anemia with IV iron and erythropoietin stimulating agents (ESAs) should be considered in the appropriate settings.
超过三分之二的恶性血液系统疾病患者存在贫血。贫血的病因主要源于骨髓浸润导致的无效红细胞生成、细胞因子相关抑制、促红细胞生成素抑制以及维生素缺乏；抗体介导的溶血和血栓性微血管病导致的清除加速进一步加剧了无效红细胞生成。由于贫血本质上是慢性的，症状通常耐受性良好且往往不具有特异性。输注红细胞是在为患者带来益处的同时避免输血风险之间的一种平衡。与宽松输血策略相比，保守/限制性红细胞输血策略已显示出相当的患者预后，荟萃分析表明住院死亡率降低、心脏事件、再出血和细菌感染减少。因此，恶性肿瘤患者较低输血阈值的影响正受到越来越多的审视。在适当情况下应考虑使用静脉铁剂和促红细胞生成素刺激剂（ESA）治疗贫血的替代管理策略。
