Erythropoiesis‐stimulating agents (ESAs) are commonly used to treat chemotherapy‐induced anemia (CIA). However, about half of patients do not benefit.
Our systematic review shows that addition of iron to ESAs offers superior hematopoietic response, reduces the risk of RBC transfusions, and improves Hb levels, and appears to be well tolerated. None of the included RCTs reported overall survival. We found no evidence for a difference in quality of life with iron supplementation.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009624.pub2/full
While patient blood management (PBM) principles are not specific to cancer patients, their application contains the pathophysiological premises that could also benefit this patient population. In this study, we assessed the effects of implementing a PBM bundle for cancer patients in the postoperative period.
Our PBM bundle positively impacted RBC transfusion appropriateness in postsurgical cancer patients, both in terms of quality and quantity. A structured PBM programme specifically dedicated to surgical oncology should cover the entire perioperative period and might further improve transfusion appropriateness in these patients. The publication of guidelines on the management of anaemia in surgical oncology should be a priority.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592164/pdf/blt-18-359.pdf
Patient Blood Management (PBM) is a systematic quality improving clinical model to reduce anemia and avoid transfusions in all kinds of clinical settings. Here, we investigated the potential of PBM in oncologic surgery and hypothesized that PBM improves 2-year overall survival (OS).
PBM is a quality improvement tool that is associated with better mid-term surgical oncologic outcome. The root cause for improvement is the increase of patients entering surgery with normal hemoglobin values.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081799/pdf/12957_2018_Article_1456.pdf
Patient Blood Management (PBM) é um método seguro que visa melhorar a gestão médico-cirúrgica dos doentes de modo a que o seu próprio sangue seja conservado. Cerca de 32 a 60% dos doentes oncológicos têm deficiência de ferro, a maioria tem anemia e, por isso, é importante discutir estratégias que evitem o uso excessivo de sangue e redução da progressão de tumores e recor-rência do cancro. Neste artigo de posicionamento, um grupo de especialistas em conjunto com a Associação Portuguesa para o Estudo da Anemia (AWGP) discute o programa PBM em hematologia e oncologia tendo em conta diver-sos fatores que são atualmente utilizados para aprovar os tratamentos em uso, baseados nas últimas informações atualizadas das orientações internacionais do National Comprehensive Cancer Network® (NCCN).
https://rponcologia.com/index.php/rpo/article/view/21/15
Anaemia and iron deficiency (ID) are frequent complications in patients with solid tumours or haematological malignancies, particularly in patients treated with chemotherapeutic agents. Frequently, anaemia is associated with fatigue, impaired physical function and reduced quality of life (QoL). Consequences of anaemia may include impaired response to cancer treatment and reduced overall survival (OS), even though a causal direct relationship has not yet been established. These new ESMO Clinical Practice Guidelines provide tools to evaluate anaemia, also in patients with myelodysplastic syndromes (MDS), and include recommendations on how to safely manage chemotherapy-induced anaemia (CIA) with erythropoiesis-stimulating agents (ESAs), iron preparations for intravenous (i.v.) or oral administration, red blood cell (RBC) transfusions and combinations of these treatments. The major aims of anaemia management are the reduction or resolution of anaemia symptoms, particularly fatigue, and an improved QoL with the minimum invasive treatment that corrects the underlying causes and proves to be safe. Underlying causes of anaemia, mainly impaired erythropoietic activity and disturbed iron homeostasis, can be consequences of increased release of inflammatory cytokines due to the underlying cancer and/or toxicity of cancer therapy. Furthermore, vitamin B12 and folate deficiency are relatively rare causes of anaemia in cancer patients.
https://www.annalsofoncology.org/article/S0923-7534(19)31688-6/pdf
Anemia is prevalent in 30% to 90% of patients with cancer. Anemia can be corrected through treating the underlying cause or providing supportive care through either transfusion with packed red blood cells (PRBC) or administration of erythropoiesisstimulating agents (ESAs), with or without iron supplementation. Recent studies showing detrimental
health effects of ESAs sparked a series of FDA label revisions and a sea change in the perception of these once commonly used agents. In light of this, these guidelines underwent substantial revisions. The purpose of these guidelines is 2-fold: 1) to operationalize the evaluation and treatment of anemia in adult patients with cancer, with an emphasis on those with anemia who are receiving concomitant chemotherapy, and 2) to enable the patient and clinician to assess anemia treatment options based on individual patient conditions.
The pathophysiologic origins of anemia can be grouped into 3 categories: 1) decreased production of functional red blood cells (RBCs), 2) increased destruction of RBCs, and 3) blood loss. Hence, anemia is characterized by a decrease in hemoglobin (Hb) concentration, RBC count, or packed cell volume to subnormal levels.
https://oncolife.com.ua/doc/nccn/Cancer-and_Chemotherapy-Induced_Anemia.pdf
The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work. pré-operatórios
https://journals.lww.com/ejanaesthesiology/Fulltext/2017/06000/Management_of_severe_perioperative_bleeding__.3.aspx
A transfusão sanguínea é essencial para o desenvolvimento da medicina moderna, e nas últimas décadas vários tratamentos médicos e cirúrgicos não podiam ter sido implementados sem recurso a esta terapêutica de suporte. Como qualquer outra terapêutica, está associada a riscos não negligenciáveis, é de disponibilidade limitada porque é uma terapêutica dependente do altruísmo dos dadores, e tem custos que devem ser conhecidos pelos médicos prescritores. É geralmente um procedimento seguro e eficaz, permite a correcção das deficiências hematológicas, prevenindo as suas consequências e quando corretamente indicada, o seu efeito benéfico ultrapassa largamente os riscos.
A avaliação da eficácia da transfusão e a monitorização dos efeitos adversos imediatos ou tardios, devem ser contemplados numa boa prática para a garantia de segurança adicional. Todos os aspectos da terapêutica transfusional têm sido alvo de investigação clínica e epidemiológica alargada e há inúmeras publicações em que as indicações clínicas dos diferentes componentes sanguíneos são avaliadas e estabelecidas sobre a forma de guias de
orientação ou normas de boas práticas. No entanto, a maioria dos estudos publicados e planeados com a finalidade de estabelecer limites para a transfusão de Concentrado de Eritrócitos, são estudos não randomizados pelo que os resultados devem ser interpretados de forma cautelosa. Assim, a decisão clínica sobre o recurso à terapêutica transfusional apesar de baseada em evidências ou estudos observacionais, será sempre um acto individualizado em
que a avaliação clínica é determinante e as orientações devem ser entendidas como uma ajuda para decisão e revistas sempre que haja novas evidências, ou novas descobertas neste campo do conhecimento.
https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0382012-de-30122012-png.aspx