Cybulska Paulina, Goss Cheryl, Tew William P, Parameswaran Rekha, Sonoda Yukio
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Hematology and Coagulation Laboratory Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecol Oncol. 2017 Aug;146(2):416-426. doi: 10.1016/j.ygyno.2017.05.010. Epub 2017 May 18.
Anemia, which is highly prevalent in oncology patients, is one of the most established negative prognostic factors for several gynecologic malignancies. Multiple factors can cause or contribute to the development of anemia in patients with gynecologic cancers; these factors include blood loss (during surgery or directly from the tumor), renal impairment (caused by platinum-based chemotherapy), and marrow dysfunction (from metastases, chemotherapy, and/or radiation therapy). Several peri- and intra-operative strategies can be used to optimize patient management and minimize blood loss related to surgery. Blood transfusions are routinely employed as corrective measures against anemia; however, blood transfusions are one of the most overused healthcare interventions. There are safe and effective evidence-based blood transfusion strategies used in other patient populations that warrant further investigation in the surgical oncology setting. Blood is a valuable healthcare resource, and clinicians can learn to use it more judiciously through knowledge of the potential risks and complications of blood interventions, as well as the ability to properly identify the patients most likely to benefit from such interventions.
贫血在肿瘤患者中非常普遍，是几种妇科恶性肿瘤最确定的不良预后因素之一。多种因素可导致或促使妇科癌症患者发生贫血；这些因素包括失血（手术期间或直接来自肿瘤）、肾功能损害（由铂类化疗引起）和骨髓功能障碍（由转移、化疗和/或放疗引起）。可以采用多种围手术期和术中策略来优化患者管理并尽量减少与手术相关的失血。输血通常作为治疗贫血的纠正措施；然而，输血是最被过度使用的医疗干预措施之一。在其他患者群体中使用的安全有效的循证输血策略值得在外科肿瘤学环境中进一步研究。血液是一种宝贵的医疗资源，临床医生可以通过了解血液干预的潜在风险和并发症以及正确识别最可能从此类干预中受益的患者的能力，学会更明智地使用血液。
