Doc - Academia

Why Blood Transfusion is Avoided in Cancer Surgery

◉ Transfusion-related immunomodulation (TRIM)
o Allogeneic blood transfusion can cause suppression of cell-mediated immunity.
o Leads to decreased natural killer (NK) cell activity, reduced T-cell function, and altered cytokine balance.
o This immunosuppression can favour tumour cell survival and proliferation.

◉ Risk of tumour recurrence and metastasis
o Studies have shown an association between peri-operative blood transfusion and increased risk of cancer recurrence and reduced overall survival in colorectal, gastric, hepatocellular, and other malignancies.
o Mechanism: circulating tumour cells during surgery + immunosuppression → easier implantation and spread.

◉ Increased infection risk
o Immunosuppression also predisposes to surgical site infection, pneumonia, and sepsis.
o Infections may delay adjuvant chemotherapy/radiotherapy.

◉ Pro-inflammatory and pro-angiogenic effects
o Stored blood products release cytokines, growth factors, and bioactive lipids.
o These may promote angiogenesis and tumour growth.

◉ Transfusion-related complications
o TRALI, TACO, febrile reactions, alloimmunisation, iron overload (with repeated transfusion).
o These increase perioperative morbidity and prolong hospital stay.

◉ Effect on survival
o Multiple meta-analyses report that peri-operative blood transfusion correlates with worse long-term survival in many cancers (though some confounding factors exist, anaemia itself, surgical complexity).

🎱 Practical Perioperative Strategy

➥ Restrictive transfusion thresholds are recommended (Hb < 7 g/dL in stable patients; < 8 g/dL if cardiovascular risk).

➥ Optimise preoperative haemoglobin with iron therapy, erythropoiesis-stimulating agents (if appropriate), correction of nutritional deficiencies.

➥ Use blood conservation methods: meticulous haemostasis, cell salvage (except in cases with contamination risk), acute normovolaemic haemodilution.

“Peri-operative allogeneic blood transfusion in cancer surgery is avoided because of transfusion-related immunomodulation, increased risk of tumour recurrence, infections, and poor survival outcomes; hence, a restrictive transfusion strategy with blood conservation is recommended.”