Blood component therapy in oncology

Abstract

Hematologic complications common in patients with cancer are usually related either to the underlying disease or to the treatment. Abnormalities in the red blood cell, leukocyte, platelet count and function may require appropriate blood component support, according to transfusion medicine expertise. Preparation methods developed in the second half of the XXth century, apheresis included, have opened the way to component replacement therapy. The technological progress in transfusion medicine has also given access to several new therapeutic methods including hematopoietic stem cells collection and transplantation.
Anemia, frequently associated with cancer and cancer therapies, not only effects the quality of patient’s life but also reduces treatment outcome and chances for survival. Anemia patients are therefore given red cell transfusions to increase the oxygen carrying capacity that cannot be adequately compensated by normal physiologic mechanisms. Recombinant human erythropoietin recently introduced in anemia treatment has proved effective without the risk commonly associated with blood transfusion.
Most platelet transfusions in cancer patients are performed prophylactically, i.e. to prevent bleeding. However, to determine the recommended threshold, dose and frequency of platelet transfusions, it is necessary to conduct more studies in diversified clinical settings.
In prolonged neutropenia, granulocyte transfusion therapy has long seemed a natural approach in the treatment of severe bacterial and fungal infections. Despite numerous clinical trials, the efficacy and safety of granulocyte transfusion therapy still remains controversial.
Blood component therapy, though often life-saving, may however result in acute or delayed complications. It should therefore be recommended mainly in conditions leading to significant morbidity or mortality, that cannot be prevented or managed effectively by other means.