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Blood Transfusion is Associated With Adverse Outcomes in Pediatric Solid Tumor Oncology Patients Following Tumor
Shannon N Acker1,2, Margo M Nolan1, Connor Prendergast1
1Division of Pediatric Surgery, Children's Hospital Colorado.
Insights
Packed red blood cell (PRBC) transfusions in children with solid tumors increase infection risk. If transfusion is needed, use single units to minimize complications.
Area of Science:
- Pediatric Oncology
- Transfusion Medicine
- Surgical Oncology
Background:
- Packed red blood cell (PRBC) transfusions, while life-saving, can cause inflammation and immune suppression.
- In adults with cancer, PRBC transfusions are linked to higher infection rates, tumor recurrence, and reduced survival.
- The impact of PRBC transfusions on children with solid tumors remains largely unexamined.
Purpose of the Study:
- To investigate the association between perioperative PRBC transfusion and outcomes in pediatric patients undergoing solid tumor resection.
- To determine if PRBC transfusion affects postoperative infectious complications, disease-free interval, and tumor recurrence in this population.
Main Methods:
- Retrospective review of pediatric patients (2002-2013) who had solid tumor resection.
- Data collected included demographics, operation details, nadir hemoglobin, and PRBC transfusion within 30 days of surgery.
- Statistical analysis adjusted for cancer stage, tumor location, chemotherapy, and nadir hemoglobin.
Main Results:
- 54% of 360 pediatric patients received perioperative PRBC transfusions.
- Transfusion was associated with increased postoperative infections, shorter disease-free intervals, and higher tumor recurrence rates.
- Each additional PRBC unit transfused significantly increased the risk of postoperative infection (OR 3.83, P=0.031).
Conclusions:
- Perioperative PRBC transfusion in children with solid tumors is linked to a higher incidence of postoperative infections.
- Minimizing PRBC transfusion and using single-unit increments when necessary is recommended to reduce adverse outcomes.
Background:
Packed red blood cell (PRBC) transfusion is a lifesaving intervention that also has proinflammatory and immunosuppressive effects. Adults with a malignancy who receive PRBC transfusion have increased rates of infection, tumor recurrence, and decreased survival. The effect of PRBC transfusion among children with solid tumors is unknown.
Methods:
We performed a retrospective review of all children who underwent operative resection of a solid tumor malignancy. Data collected included demographic information, location of operation, nadir hemoglobin, and any PRBC transfusion within 30 days of tumor resection.
Results:
Three hundred sixty children underwent tumor resection at our institution between 2002 and 2013; 194 (54%) received a perioperative blood transfusion. After adjusting for stage at diagnosis, tumor location, preoperative chemotherapy and nadir hemoglobin, blood transfusion was associated with a higher rate of postoperative infectious complications, shorter disease-free interval, and a higher rate of tumor recurrence. Each additional transfused unit increased the risk of postoperative infection (odds ratio 3.83; 95% confidence interval 1.21, 14.22, P =0.031).
Conclusions:
Among children with solid tumor malignancies, PRBC transfusion within 30 days of operation is associated with higher rates of postoperative infection. If transfusion becomes necessary, single unit increments should be transfused.
Level Of Evidence:
Level III.
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