Transfusion Therapy: Is There a Link with Cancer Recurrence?

Abstract

To present an updated narrative review of the available clinical evidence regarding the impact of perioperative anemia and blood product administration on cancer recurrence and mortality. To address some of the current strategies to reduce blood transfusions and their safety in oncologic surgery. Both anemia and packed red blood cells (pRBCs) transfusions have been associated with an increased risk of recurrence and mortality in certain solid malignancies. Anemia directly stimulates protective mechanisms against apoptosis of cancer cells while promoting a favorable micro-environment and reducing the efficacy of anticancer therapies. When transfusion occurs, transfusion-related immunomodulation (TRIM) mediates the immunosuppression and inflammation responsible for the impairment of the host immune system to appropriately eliminate cancer cells. However, pRBCs can also promote tumor growth by non-TRIM mechanisms. Evidence of the negative impact of perioperative anemia and blood transfusions on cancer recurrence and mortality should raise concern about the appropriate timing of blood transfusions in patients with cancer undergoing surgical procedures. Blood sparing strategies such as acute normovolemic hemodilution, autologous pRBCs transfusions and intraoperative cell savage appear to be safe means to minimize allogeneic pRBCs in the context of cancer surgery, although the safety of these strategies has not been rigorously tested in randomized controlled trials.