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How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology
- Source :
- Cancer Treatment Reviews. 46:1-8
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Background Most non-oncologic clinical practice guidelines recommend restrictive allogeneic blood transfusion practices; however, there is a lack of consensus regarding the best transfusion practice in oncology. We conducted a systematic review of the literature to compare the efficacy and safety of restrictive versus liberal transfusion strategies in patients with cancer. Methods A literature search using MEDLINE, PUBMED and EMBASE identified all controlled studies comparing the use of restrictive with liberal transfusion in adult oncology participants up to August 10, 2015. Two review authors independently assessed studies for inclusion, extracted data and appraised the quality of the included studies. The primary outcomes of interest were blood utilization and all-cause mortality. Results Out of 4241 citations, six studies (3 randomized and 3 non-randomized) involving a total of 983 patients were included in the final review. The clinical context of the studies varied with 3 chemotherapy and 3 surgical studies. The overall risk of bias in all studies was moderate to high. Restrictive transfusion strategies were associated with a 36% reduced risk of receiving a perioperative transfusion (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.49–0.83). There was no difference in mortality between the strategies (RR 1.00, 95% CI 0.32–3.18). There were no differences in adverse events reported between the restrictive and liberal transfusion strategies. Conclusion Restrictive strategy appears to decrease blood utilization without increasing morbidity or mortality in oncology. This review is limited by a paucity of high quality studies on this topic. Better designed studies are warranted.
- Subjects :
- Oncology
medicine.medical_specialty
Red Blood Cell Transfusion
MEDLINE
Context (language use)
030204 cardiovascular system & hematology
Medical Oncology
Article
03 medical and health sciences
0302 clinical medicine
Neoplasms
Internal medicine
Humans
Transplantation, Homologous
Medicine
Radiology, Nuclear Medicine and imaging
Adverse effect
Randomized Controlled Trials as Topic
business.industry
General Medicine
Perioperative
Confidence interval
030220 oncology & carcinogenesis
Meta-analysis
Relative risk
Erythrocyte Transfusion
business
Subjects
Details
- ISSN :
- 03057372
- Volume :
- 46
- Database :
- OpenAIRE
- Journal :
- Cancer Treatment Reviews
- Accession number :
- edsair.doi.dedup.....f1d11776dbac851a0e4bc3238a374fd4