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. 1988 Apr;207(4):410–415. doi: 10.1097/00000658-198804000-00007

Further evidence supporting a cause and effect relationship between blood transfusion and earlier cancer recurrence.

N Blumberg 1, J Heal 1, C Chuang 1, P Murphy 1, M Agarwal 1
PMCID: PMC1493418  PMID: 3355265

Abstract

Studies of associations between perioperative blood transfusions and later recurrence of solid tumors have yielded conflicting results. A previous analysis of transfused patients suggested that recurrence was associated with transfusion of whole blood as opposed to red blood cell concentrates. Additional analyses were performed on patients with cancers of the colon, rectum, cervix, and prostate to determine if patients receiving whole blood, red blood cells only, or no transfusions had differing outcomes. Patients receiving 1 unit or more of whole blood had uniformly poor outcomes compared with nontransfused patients (p less than 0.001). In contrast, patients receiving only red blood cells had progressively worse recurrence and death rates with increasing numbers of transfusion, suggesting the presence of a dose-effect relationship. Employing multivariate techniques, blood transfusion of less than or equal to 3 units that included any whole blood were independently and significantly associated with earlier recurrence (p = 0.003) and death due to cancer (p = 0.02). Transfusions of less than or equal to 3 units of blood comprised solely of red blood cell concentrates were associated with no greater risk of recurrence than that seen in patients receiving no transfusion (p = 0.50). These results provide a potential explanation for the disparate results reported in studies of blood transfusion and cancer outcome. The marked difference in outcome seen between patients receiving a few units of red blood cells and comparable patients receiving even one unit of whole blood are consistent with the hypothesis that transfusion of stored blood plasma causes earlier tumor recurrence in some instances. Strategies for reducing these risks might include avoidance of whole blood transfusions when only 1-3 units are required, more conservative transfusion practice, use of autologous blood transfusions, and perhaps, use of red blood cells washed free of plasma and white cell debris. Clinical trials to test these hypotheses are urgently needed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Blumberg N., Agarwal M. M., Chuang C. Relation between recurrence of cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 1985 Apr 6;290(6474):1037–1039. doi: 10.1136/bmj.290.6474.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blumberg N., Heal J. M., Murphy P., Agarwal M. M., Chuang C. Association between transfusion of whole blood and recurrence of cancer. Br Med J (Clin Res Ed) 1986 Aug 30;293(6546):530–533. doi: 10.1136/bmj.293.6546.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blumberg N., Heal J. M. Perioperative blood transfusion and solid tumour recurrence. Blood Rev. 1987 Dec;1(4):219–229. doi: 10.1016/0268-960x(87)90023-3. [DOI] [PubMed] [Google Scholar]
  4. Burrows L., Tartter P. Effect of blood transfusions on colonic malignancy recurrent rate. Lancet. 1982 Sep 18;2(8299):662–662. doi: 10.1016/s0140-6736(82)92764-7. [DOI] [PubMed] [Google Scholar]
  5. Corman J., Arnoux R., Péloquin A., St-Louis G., Smeesters C., Giroux L. Blood transfusions and survival after colectomy for colorectal cancer. Can J Surg. 1986 Sep;29(5):325–329. [PubMed] [Google Scholar]
  6. Fielding L. P. Red for danger: blood transfusion and colorectal cancer. Br Med J (Clin Res Ed) 1985 Sep 28;291(6499):841–842. doi: 10.1136/bmj.291.6499.841. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Foster R. S., Jr, Costanza M. C., Foster J. C., Wanner M. C., Foster C. B. Adverse relationship between blood transfusions and survival after colectomy for colon cancer. Cancer. 1985 Mar 15;55(6):1195–1201. doi: 10.1002/1097-0142(19850315)55:6<1195::aid-cncr2820550610>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  8. Foster R. S., Jr, Foster J. C., Costanza M. C. Blood transfusions and survival after surgery for breast cancer. Arch Surg. 1984 Oct;119(10):1138–1140. doi: 10.1001/archsurg.1984.01390220024005. [DOI] [PubMed] [Google Scholar]
  9. Francis D., Judson R. Relation between recurrence of cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 1985 Aug 24;291(6494):544–544. doi: 10.1136/bmj.291.6494.544-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Frankish P. D., McNee R. K., Alley P. G., Woodfield D. G. Relation between cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 1985 Jun 15;290(6484):1827–1827. doi: 10.1136/bmj.290.6484.1827-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hamblin T. J. Blood transfusions and cancer: anomalies explained? Br Med J (Clin Res Ed) 1986 Aug 30;293(6546):517–518. doi: 10.1136/bmj.293.6546.517-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hyman N. H., Foster R. S., Jr, DeMeules J. E., Costanza M. C. Blood transfusions and survival after lung cancer resection. Am J Surg. 1985 Apr;149(4):502–507. doi: 10.1016/s0002-9610(85)80047-7. [DOI] [PubMed] [Google Scholar]
  13. Kay L. A. The need for autologous blood transfusion. Br Med J (Clin Res Ed) 1987 Jan 17;294(6565):137–139. doi: 10.1136/bmj.294.6565.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Manyonda I. T., Shaw D. E., Foulkes A., Osborn D. E. Renal cell carcinoma: blood transfusion and survival. Br Med J (Clin Res Ed) 1986 Aug 30;293(6546):537–538. doi: 10.1136/bmj.293.6546.537-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Moffat L. E., Sunderland G. T. Relation between recurrence of cancer and blood transfusion. Br Med J (Clin Res Ed) 1985 Oct 5;291(6500):971–971. doi: 10.1136/bmj.291.6500.971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Nathanson S. D., Tilley B. C., Schultz L., Smith R. F. Perioperative allogeneic blood transfusions. Survival in patients with resected carcinomas of the colon and rectum. Arch Surg. 1985 Jun;120(6):734–738. doi: 10.1001/archsurg.1985.01390300076013. [DOI] [PubMed] [Google Scholar]
  17. Nowak M. M., Ponsky J. L. Blood transfusion and disease-free survival in carcinoma of the breast. J Surg Oncol. 1984 Oct;27(2):124–130. doi: 10.1002/jso.2930270214. [DOI] [PubMed] [Google Scholar]
  18. Ota D., Alvarez L., Lichtiger B., Giacco G., Guinee V. Perioperative blood transfusion in patients with colon carcinoma. Transfusion. 1985 Jul-Aug;25(4):392–394. doi: 10.1046/j.1537-2995.1985.25485273825.x. [DOI] [PubMed] [Google Scholar]
  20. Parrott N. R., Lennard T. W., Taylor R. M., Proud G., Shenton B. K., Johnston I. D. Effect of perioperative blood transfusion on recurrence of colorectal cancer. Br J Surg. 1986 Dec;73(12):970–973. doi: 10.1002/bjs.1800731208. [DOI] [PubMed] [Google Scholar]
  21. Pastorino U., Valente M., Cataldo I., Lequaglie C., Ravasi G. Perioperative blood transfusion and prognosis of resected stage Ia lung cancer. Eur J Cancer Clin Oncol. 1986 Nov;22(11):1375–1378. doi: 10.1016/0277-5379(86)90148-3. [DOI] [PubMed] [Google Scholar]
  22. Rosenberg S. A., Seipp C. A., White D. E., Wesley R. Perioperative blood transfusions are associated with increased rates of recurrence and decreased survival in patients with high-grade soft-tissue sarcomas of the extremities. J Clin Oncol. 1985 May;3(5):698–709. doi: 10.1200/JCO.1985.3.5.698. [DOI] [PubMed] [Google Scholar]
  23. Tartter P. I., Burrows L., Kirschner P. Perioperative blood transfusion adversely affects prognosis after resection of Stage I (subset N0) non-oat cell lung cancer. J Thorac Cardiovasc Surg. 1984 Nov;88(5 Pt 1):659–662. [PubMed] [Google Scholar]
  24. Tartter P. I., Burrows L., Papatestas A. E., Lesnick G., Aufses A. H., Jr Perioperative blood transfusion has prognostic significance for breast cancer. Surgery. 1985 Feb;97(2):225–230. [PubMed] [Google Scholar]

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