ABSTRACT
Cancer patients frequently experience clinically significant anemia, which is often exacerbated by surgery and myelosuppressive chemotherapy. Although consistent with the anemia of chronic disease, several factors, including the type of tumor, blood loss, nutritional deficiencies, hemolysis, bone marrow infiltration by malignant cells, low serum erythropoietin (Epo) levels, and a decrease in bone marrow responsiveness to recombinant human Epo, may contribute to cancer-induced anemia and significantly influence the percentage of patients needing blood transfusion during chemotherapy. Recently, the traditional belief that blood transfusion is an effective and safe therapy has been challenged by an increased awareness of the infectious and immunologic risks associated with allogeneic blood transfusion. In cancer patients transfusion-induced immunomodulation may have the potential to significantly increase postoperative infections and cancer recurrence, so it seems reasonable to minimize allogeneic blood exposure. During chemotherapy, patients treated with platinum-based regimens more often develop anemia and require transfusions. In this group of patients, the cumulative dose of platinum, as well as advanced age, loss of body weight before treatment, advanced disease stage, and a low primary level of Hb (11 g/dL) or a decrease in Hb level (1-2 g/dL) after the first cycle of chemotherapy, represent important risk factors for increased frequency of transfusions.
