Abstract
Patients with cancer have increased risk of thrombosis and often need red blood cell
(RBC) transfusions. However, RBC transfusions may also promote thrombosis because
of raised hematocrit and viscosity, storage-related RBC damage, and exposure to thrombogenic
mediators from obsolescent RBCs. The authors conducted a literature survey for studies
examining whether RBC transfusions were associated with increased risk of venous thromboembolism
(VTE) in cancer patients. In perioperative cancer surgery patients with categorical
comparisons of any versus no RBC transfusion, increased risk of VTE with RBC transfusion
was found in 11 of 31 studies, 5 by univariate correlation only and 6 in multivariate
analysis. All six multivariate-positive studies had intermediate overall rates of
thrombosis (1.4–6.0%), and three were in urological surgery series. In the larger
studies of > 2,000 patients (range: 2,219–44,656), the maximum odds ratio among the
multivariate-positive studies was 1.3. Perioperative RBC transfusion volume was more
strongly associated with VTE risk, with a positive association in six of seven studies.
One large registry-based study of hospitalized cancer patients, not restricted to
the perioperative setting, found an adjusted odds ratio of 1.60 (95% confidence interval:
1.53–1.67) for VTE risk in patients receiving RBCs compared with nontransfused patients.
Keywords
cancer - red blood cell transfusion - postoperative complications - venous thromboembolism
