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Semin Thromb Hemost 2019; 45(06): 648-656
DOI: 10.1055/s-0039-1694763
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Thrombosis Risk in Cancer Patients Receiving Red Blood Cell Transfusions

Glenn Ramsey
1   Department of Pathology, Blood Bank, Northwestern Memorial Hospital, Chicago, Illinois
2   Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
Paul F. Lindholm
2   Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
3   Department of Pathology, Hemostasis Laboratory, Northwestern Memorial Hospital, Chicago, Illinois
› Author Affiliations Funding No external financial support was received for this work.
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Publication History

Publication Date:
20 August 2019 (online)

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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
 

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