INDICATIONS FOR AND COMPLICATIONS OF

TRANSFUSION AND THE MANAGEMENT OF

GYNECOLOGIC MALIGNANCIES
Supervisor :
dr. Sarah Dina, Mked(OG), SpOG(K)

Oncology and Gynaecology Division

Medical Faculty- Universitas Sumatera Utara
2017
ANEMIA IN THE CANCER PATIENT
DISEASE
PROGRESSION BLOOD
ANEMIA
CONSEQUENCE TRANSFUSION
TREATMENT

MILD MODERATE SEVERE

11-11.9 8-10.9 <8

C
S USA: 6 MILLION UNITS RBCS ANNUALLY 34% ONCOLOGY PATIENT O
Y GYNECOLOGIC MALIGNANCIES : 11.6% M
M P
E
P SYMPTOM : REDUCTION OF HB CONCENTRATION BELOW 5 G/DL N
T S
O POSTOPERATIVE: LOW RISK 7.1-8 A
T
M MORTALITY RATE 34.4% 4.1-5 E
RETICULOCYTE TUMOR CELL
CREATININE
IRON ANEMIA CYTOKINE
B-12
CRA
FOLIC ACID IMMUNE SYSTEM

RENAL MARROW
BLOOD LOSS
DYSFUNCTION DYSFUNCTION

DECREASED SURVIVAL ; INCREASED MORTALITY

 88.3

TISSUE LOCOREGIONAL
OXYGENATION CONTROL
RADIATION
DECREASE THERAPY TUMOR
HB PROGRESSION
INDICATIONS FOR TRANSFUSION
7 gr/dL IN STABLE HOSPITALIZED PATIENTS

HB CONCENTRATION IS < 6 g/dL

SURGICAL PATIENT HB CONCENTRATION OF 8G/DL

RESTRICTIVE STRATEGY OF RBC TRANSFUSION WAS NON-INFERIOR AND PERHAPS

SUPERIOR TO A LIBERAL STRATEGY

CRIT STUDY
THE NUMBER OF RBC UNITS TRANSFUSED IN THE CRITICALLY ILL IS AN INDEPENDENT
PREDICTOR OF WORSE CLINICAL OUTCOME
RISKS ASSOCIATED WITH BLOOD TRANSFUSION

IMMUNO-
TRANSFUSION LUNG MODULATION INFECTIOUS
REACTION INJURY TUMOR RISK
RECURRENCE

ACUTE

ACUTE HEMOLYTIC
FEBRILE NON-HEMOLYTIC
DELAYED TRANSFUSION-RELATED ACUTE LUNG INJURY
ALLERGIC TRANSFUSION REACTION
RISKS ASSOCIATED WITH BLOOD TRANSFUSION
IMMUNO-
TRANSFUSION LUNG MODULATION INFECTIOUS
REACTION INJURY TUMOR RISK
RECURRENCE

REACTION BETWEEN DONOR LEUKOCYTE

ANTIBODIES AND RECIPIENT ANTIGENS, CAUSING A
DOWNSTREAM, CYTOKINE-MEDIATED INTERACTION
BETWEEN NEUTROPHILS AND THE LUNG
ENDOTHELIUM
TRANSFUSION-ASSOCIATED CARDIAC OVERLOAD
RISKS ASSOCIATED WITH BLOOD TRANSFUSION

IMMUNO-
TRANSFUSION LUNG MODULATION INFECTIOUS
REACTION INJURY TUMOR RISK
RECURRENCE

ALLOGENEIC BLOOD TRANSFUSION-RELATED IMMUNE MODULATION

SUPPRESSING HOST NATURAL KILLER CELLS AND ACTIVATING SUPPRESSOR T-
LYMPHOCYTES

PERI- AND POSTOPERATIVE BLOOD TRANSFUSIONS ALSO INCREASED RISK OF

VENOUS THROMBOEMBOLISM (VTE), HIGHER COMPOSITE MORBIDITY, MORTALITY,
AND LENGTH OF HOSPITAL STAY
RISKS ASSOCIATED WITH BLOOD TRANSFUSION

IMMUNO-
TRANSFUSION LUNG MODULATION INFECTIOUS
REACTION INJURY TUMOR RISK
RECURRENCE

PI TECHNOLOGY : INACTIVATE, REMOVE, OR REDUCE ANY PATHOGENS THAT ARE

PRESENT IN THE BLOOD PRODUCT AND PREVENT FROM GROWING OR
REPRODUCING NON-INFECTIOUS
PERI-OPERATIVE MANAGEMENT OF ANEMIA
DIAGNOSIS:
SCREENING COMPLETE BLOOD COUNT (34 WEEKS PRIOR TO A PLANNED SURGICAL
PROCEDURE)

T
IRON REPLACEMENT
H
E
R
A
P
Y ERYTHROPOIESIS-STIMULATING AGENTS

EPOETIN OR DARBEPOETIN FOR PATIENTS WITH CHEMOTHERAPY-ASSOCIATED

ANEMIA AND AN HB LEVEL <10 g/dL (GOAL HB CONCENTRATIONS 12 g/dL)

THROMBOEMBOLIC EVENTS
INTRAOPERATIVE MANAGEMENT AND PREVENTION OF
BLOOD LOSS AND ANEMIA

CELL SALVAGE

ACUTE
TRANEXAMIC
NORMOVOLEMIC
ACID
HEMODILUTION

REDUCED
MANAGEMENT
LABORATORY-
OF
ASSOCIATED
COAGULOPATHY
BLOOD LOSS
PATIENT-CENTERED TRANSFUSION STRATEGIES

PERIOPERATIVE
ANEMIA
MANAGEMENT

PATIENT
COAGULOPATHY
OUTCOME
MANAGEMENT
METRICS PBM
PROGRAM

PATIENT BLOOD
CENTERED CONSERVATION
TRANSFUSION STRATEGIES
BLOOD ALTERNATIVES
CANNOT BE GIVEN CONVENTIONAL BLOOD PRODUCTS
COMPATIBLE BLOOD CANNOT BE FOUND

HEMOGLOBIN-BASED OXYGEN CARRIER (HBOC)

PEGYLATED BOVINE DUAL-ACTION CO-RELEASING/OXYGEN TRANSFER AGENT

INHIBIT VASOCONSTRICTION, DECREASE RBC EXTRAVASATION, LIMIT REACTIVE

OXYGEN SPECIES PRODUCTION, ENHANCE BLOOD RHEOLOGY, AND DELIVER
OXYGEN TO TISSUES

HUMAN IMMORTALIZED ADULT ERYTHROID LINE

CONCLUSIONS
BLOOD TRANSFUSIONS ARE OFTEN USED IN PATIENTS WITH GYNECOLOGIC
MALIGNANCIES

MAINLY GUIDED BY ANECDOTAL EXPERIENCE RATHER THAN PUBLISHED GUIDELINES

OR DATA FROM RCT

IMPROVE TISSUE OXYGEN DELIVERY AND QUALITY OF LIFE

LINK BETWEEN TRANSFUSION, PROGNOSIS, AND RECURRENCE IS PROVOCATIVE BUT

CONFOUNDING, AND SHOULD CAUTION THE SURGEON'S DECISION-MAKING

RESTRICTIVE BLOOD TRANSFUSION STRATEGIES HAVE BEEN PROVEN TO BE SAFE