Goubran Hadi, Seghatchian Jerard, Prokopchuk-Gauk Oksana, Radosevic Julia, Sabry Waleed, Iqbal Nayyer, Burnouf Thierry
Saskatoon Cancer Centre, Saskatchewan Cancer Agency, Saskatoon, Canada; College of Medicine, University of Saskatchewan, Saskatoon, Canada.
International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK.
Transfus Apher Sci. 2017 Jun;56(3):322-329. doi: 10.1016/j.transci.2017.05.018. Epub 2017 May 26.
Transfusion of red blood cells, platelets and plasma is widely used in the management of anemia and coagulopathy in cancer patients undergoing surgery, chemotherapy, and radiation. The decision to transfuse should not be made lightly as exposure to transfused blood, whether from an allogeneic or even autologous source, is not without risk and the long-term effect of blood transfusion on cancer outcomes remains questionable. Recognition of anemia associated with nutritional deficiency should be promptly corrected while avoiding the use of erythropoiesis stimulating agents. Minimizing blood loss and the prompt control of bleeding, coupled with a restrictive transfusion strategy, seem to be a reasonable approach that does not appear to be associated with long-term sequelae. Limiting platelet transfusion to patients with severe hypo-proliferative thrombocytopenia, and implementation of local hemostatic measures, together with the use of fractionated coagulation factor concentrates, as an alternative to frozen plasma transfusion, may reduce the exposure of cancer patients to potentially harmful thrombogenic and pro-inflammatory cellular microparticles. This joint narrative highlights current opinions for minimizing blood usage in patients with cancer.
红细胞、血小板和血浆的输注广泛应用于接受手术、化疗和放疗的癌症患者贫血和凝血病的治疗中。输血的决定不应轻易做出，因为接触输注的血液，无论是来自异体还是自体来源，都并非没有风险，而且输血对癌症预后的长期影响仍存在疑问。应及时纠正对与营养缺乏相关贫血的认识，同时避免使用促红细胞生成素。尽量减少失血并迅速控制出血，再加上限制性输血策略，似乎是一种合理的方法，且似乎与长期后遗症无关。将血小板输注限制在严重低增殖性血小板减少症患者，并实施局部止血措施，同时使用凝血因子浓缩物替代冷冻血浆输注，可能会减少癌症患者接触潜在有害的血栓形成和促炎细胞微粒的机会。本联合述评强调了目前关于减少癌症患者用血的观点。
