Indications for and complications of transfusion and the management of gynecologic malignancies

Gynecol Oncol. 2017 Aug;146(2):416-426. doi: 10.1016/j.ygyno.2017.05.010. Epub 2017 May 18.

Abstract

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.

Keywords: Anemia; Blood transfusion; Cancer; Gynecologic malignancy.

Publication types

  • Review

MeSH terms

  • Acute Lung Injury / etiology
  • Anemia / etiology
  • Anemia / therapy*
  • Antifibrinolytic Agents / therapeutic use
  • Blood Loss, Surgical / prevention & control
  • Erythrocyte Transfusion / adverse effects
  • Erythrocyte Transfusion / methods*
  • Female
  • Genital Neoplasms, Female / complications
  • Genital Neoplasms, Female / surgery*
  • Hematinics / therapeutic use*
  • Hemodilution / methods*
  • Humans
  • Immunomodulation
  • Infections / etiology
  • Iron / therapeutic use
  • Neoplasm Recurrence, Local / epidemiology
  • Operative Blood Salvage / methods*
  • Perioperative Care / methods*
  • Tranexamic Acid / therapeutic use
  • Transfusion Reaction / etiology

Substances

  • Antifibrinolytic Agents
  • Hematinics
  • Tranexamic Acid
  • Iron