title: Supportive transfusion therapy in cancer patients with acquired defects of hemostasis.
abstract: Bleeding occurs in approximately 10% of patients with cancer: supportive transfusion therapy with Platelets Concentrates (PC), Fresh Frozen Plasma (FFP) and plasma-derived or recombinant concentrates is often required for the cessation and prevention of the bleeding episodes. The most frequent causes of bleeding in cancer is thrombocytopenia followed by liver insufficiency with or without vitamin K deficiency, disseminated intravascular coagulation (DIC) and the inappropriate or excessive use of anticoagulants. Other acquired hemostatic defects such as acquired hemophilia (AHA) and acquired von Willebrand syndrome (AVWS) are rare but they can be life-threatening. Thrombocytopenia in cancer patients may be the consequence of marrow invasion, chemotherapy or platelet auto-antibodies; patients with severe hypoproliferative thrombocytopenia, must be treated with PC and carefully followed to assess refractoriness to PC. The management of the other acquired defects of hemostasis usually requires the use of FFP and specific plasma-derived or recombinant concentrates. PC, FFP and plasma-derived concentrates can induce complications and/or adverse events in cancer patients: these include mainly allergic (ALR) or anaphylactic reactions (ANR), Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD), Trasfusion-transmitted bacteriemia (TTB), Transfusion-Related Acute Lung Injury (TRALI), Acute Hemolytic Transfusion Reactions (AHTR), Febrile Non Hemolytic Transfusion Reactions (FNHTR). Therefore, modifications such as leukocyte-reduction and irradiation of the blood components to be transfused in cancer patients are recommended to reduce the risk of these complications.
authors.affiliation: Hematology and Transfusion Medicine, L. Sacco University Hospital and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. Electronic address: augusto.federici@unimi.it.
authors.forename: Augusto B
authors.initials: AB
authors.lastname: Federici
authors.affiliation: Hematology and Transfusion Medicine, L. Sacco University Hospital and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Intini
authors.affiliation: Hematology and Transfusion Medicine, L. Sacco University Hospital and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Lattuada
authors.affiliation: Hematology and Transfusion Medicine, L. Sacco University Hospital and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Vanelli
authors.affiliation: Hematology and Transfusion Medicine, L. Sacco University Hospital and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Arrigoni
authors.affiliation: Hematology and Transfusion Medicine, L. Sacco University Hospital and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Sacchi
authors.affiliation: Hematology and Transfusion Medicine, L. Sacco University Hospital and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Russo
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000379:methods*; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D009369:Neoplasms / Q000097:blood / Q000150:complications*; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects / Q000379:methods*; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy*; D065227:Transfusion Reaction / Q000209:etiology*
chemical_list: D000925:Anticoagulants
keywords: Acquired defects of hemostasis; Acquired hemophilia; Bleeding in cancer; Fresh frozen plasma; Leukocyte reduction and irradiation of blood components; Plasma-derived or recombinant concentrates; Platelet concentrates; Thrombocytopenia; Transfusion-associated complications