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Blood transfusion practices in cancer surgery.

Cata JP, Gottumukkala V - Indian J Anaesth (2014)

Bottom Line: Transfusion-related immune modulation is a complication associated with the administration of blood products.A decreased immune surveillance as a consequence of blood transfusions has been linked to cancer recurrence and progression.Two meta-analyses suggest that the administration of blood products is associated with shorter recurrence-free survival and overall survival after colorectal cancer surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA ; Outcomes Research Consortium, USA.

ABSTRACT
Cancer patients are commonly transfused with blood products immediately before, during or after major surgery. Blood loss and haemodilution are the most common causes of red blood cells (RBCs) administration and coagulopathies are the indications for the infusion of fresh-frozen plasma (FFP), cryoprecipitates and platelets. Transfusion-related immune modulation is a complication associated with the administration of blood products. A decreased immune surveillance as a consequence of blood transfusions has been linked to cancer recurrence and progression. Moreover, soluble factors present in packed RBCs, platelets and FFP can directly stimulate tumour growth and spread. Two meta-analyses suggest that the administration of blood products is associated with shorter recurrence-free survival and overall survival after colorectal cancer surgery. More studies are needed to show such association in different cancer patient populations.

No MeSH data available.


Related in: MedlinePlus

Possible mechanisms associated with tumor growth and spread after blood products administration
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Figure 1: Possible mechanisms associated with tumor growth and spread after blood products administration

Mentions: The administration of blood products has been associated with profound negative effects on the immune system. At cellular level, some of the features of TRIM are: (a) a reduction in the function of natural killer (NK) cells, (b) a decrease in the proliferation of T and B lymphocytes, (c) induction of T regulatory cells and (d) a decrease in maturation and antigen presenting activity of dendritic cells.[7] Some of the described cellular and humoral alterations observed after BT are more exaggerated following the administration of ‘older’ blood units (storage lesion) since the exposure of lymphocytes to fresh blood does not affect their proliferative activity. To further illustrate some of the effect of BT on cellular immunity, Guo et al. recently demonstrated that the administration of allogeneic blood to patients undergoing gastrointestinal surgery caused a significant decrease in the number of NK cells that was not observed in patients who received autologous blood.[8] Most of the changes described at the cellular levels are the result of the infusion into the recipient of high concentrations of interleukins (IL-1β, IL-6, IL-8), chemokines, prostaglandin E, thromboxanes, histamine, leukocytes (in non-leucoreduced units or residual leukocytes in leucoreduced units), growth factors (transforming growth factor-β [TGF-β] vascular endothelial growth factor [VEGF] and epidermal growth factor, fibroblast growth factor and platelet-derived growth factor), non-polar lipids, proinflammatory lysophosphatidylcholines, CD40 ligand and microparticles present in RBCs, platelets or FFP units [Figure 1].[9]


Blood transfusion practices in cancer surgery.

Cata JP, Gottumukkala V - Indian J Anaesth (2014)

Possible mechanisms associated with tumor growth and spread after blood products administration
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260312&req=5

Figure 1: Possible mechanisms associated with tumor growth and spread after blood products administration
Mentions: The administration of blood products has been associated with profound negative effects on the immune system. At cellular level, some of the features of TRIM are: (a) a reduction in the function of natural killer (NK) cells, (b) a decrease in the proliferation of T and B lymphocytes, (c) induction of T regulatory cells and (d) a decrease in maturation and antigen presenting activity of dendritic cells.[7] Some of the described cellular and humoral alterations observed after BT are more exaggerated following the administration of ‘older’ blood units (storage lesion) since the exposure of lymphocytes to fresh blood does not affect their proliferative activity. To further illustrate some of the effect of BT on cellular immunity, Guo et al. recently demonstrated that the administration of allogeneic blood to patients undergoing gastrointestinal surgery caused a significant decrease in the number of NK cells that was not observed in patients who received autologous blood.[8] Most of the changes described at the cellular levels are the result of the infusion into the recipient of high concentrations of interleukins (IL-1β, IL-6, IL-8), chemokines, prostaglandin E, thromboxanes, histamine, leukocytes (in non-leucoreduced units or residual leukocytes in leucoreduced units), growth factors (transforming growth factor-β [TGF-β] vascular endothelial growth factor [VEGF] and epidermal growth factor, fibroblast growth factor and platelet-derived growth factor), non-polar lipids, proinflammatory lysophosphatidylcholines, CD40 ligand and microparticles present in RBCs, platelets or FFP units [Figure 1].[9]

Bottom Line: Transfusion-related immune modulation is a complication associated with the administration of blood products.A decreased immune surveillance as a consequence of blood transfusions has been linked to cancer recurrence and progression.Two meta-analyses suggest that the administration of blood products is associated with shorter recurrence-free survival and overall survival after colorectal cancer surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA ; Outcomes Research Consortium, USA.

ABSTRACT
Cancer patients are commonly transfused with blood products immediately before, during or after major surgery. Blood loss and haemodilution are the most common causes of red blood cells (RBCs) administration and coagulopathies are the indications for the infusion of fresh-frozen plasma (FFP), cryoprecipitates and platelets. Transfusion-related immune modulation is a complication associated with the administration of blood products. A decreased immune surveillance as a consequence of blood transfusions has been linked to cancer recurrence and progression. Moreover, soluble factors present in packed RBCs, platelets and FFP can directly stimulate tumour growth and spread. Two meta-analyses suggest that the administration of blood products is associated with shorter recurrence-free survival and overall survival after colorectal cancer surgery. More studies are needed to show such association in different cancer patient populations.

No MeSH data available.


Related in: MedlinePlus