Blood Transfusions, Thrombosis, and Mortality in Hospitalized Patients With Cancer

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Abstract
Anemia is observed in 30% to 90% of patients with cancer.1 It is exacerbated by blood loss during surgery, myelosuppression related to chemotherapy, and radiotherapy.2,3 Anemia can result in symptoms such as fatigue and angina in patients with coronary artery disease, and it is associated with a reduction in quality of life. Erythropoiesis-stimulating agents (ESAs) are often used to treat anemia in patients with cancer. However, recent studies4-6 suggest an increased risk of thromboembolic complications and decreased survival with the use of ESAs in cancer. This has led to a Food and Drug Administration advisory restricting their use.7 Red blood cell (RBC) transfusions are often used as an alternative treatment for anemia in patients with cancer and are recommended as therapeutic options by the American Society of Clinical Oncology/American Society of Hematology guidelines.2 However, there are no randomized controlled trials, to our knowledge, demonstrating improved outcomes or quality of life in patients with cancer receiving transfusions, and the safety profile of RBC transfusion in patients with cancer has not been studied as rigorously as has that of ESAs.