Reflections on multiple strategies to reduce transfusion in cancer patients: A joint narrative.

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.

The microbiome and transfusion in cancer patients.

Our microbiota is determined by many variables including ABO blood groups. The microbiota is not only confined to the gut and skin but is also recoverable from blood of healthy donors. The microbiota shape our immune system through cross reactivity with antigens, the expression of direct molecular patterns, the release of cytokines, the effects on nutrients and micronutrients and even through an interplay with epigenetics.

Transfusion-related immunomodulation and cancer.

Blood and blood-component therapy triggers immunological reactions in recipients. Transfusion-related immunomodulation [TRIM] is an important complex biological immune reaction to transfusion culminating in immunosuppression. The mechanisms underlying TRIM include the presence of residual leukocytes and apoptotic cells, the transfusion of immunosuppressive cytokines either present in donor components or generated during blood processing, the transfer of metabolically active growth factor-loaded microparticles and extracellular vesicles and the presence of free hemoglobin or extracellular vesicle-bound hemoglobin.

Platelet transfusion in thrombocytopenic cancer patients: Sometimes justified but likely insidious.

The transfusion of platelet concentrates prepared from allogeneic single or pooled donations is a standard procedure in transfusion medicine to stop or prevent bleeding in cancer patients with thrombocytopenia undergoing surgery, chemotherapy and/or radiotherapy. While platelet transfusion may appear reasonable in many instances, greater scientific and medical attention should however be given to the possibly insidious impact of transfused platelets on the outcome of cancers. Indeed platelets and the microvesicles they release possess all the biological ingredients capable of supporting tumor growth, protecting circulating tumor cells, and to contributing to metastatic invasion.

Red blood cell transfusion and outcome in cancer.

Oncology services utilize about 15% of the blood transfusion resources in the USA. Red blood cell transfusion is performed immediately before, during or after major surgery to compensate for blood loss and hemodilution. However, a lack of evidence-based guidelines leads to variable transfusion practices among clinicians.