Use of iron sucrose and red blood cell transfusions in anaemic cancer patients in France (OncoFer study)

AbstractPatients with cancer have increased risk of thrombosis and often need red blood cell (RBC) transfusions. However, RBC transfusions may also promote thrombosis because of raised hematocrit and viscosity, storage-related RBC damage, and exposure to thrombogenic mediators from obsolescent RBCs. The authors conducted a literature survey for studies examining whether RBC transfusions were associated with increased risk of venous thromboembolism (VTE) in cancer patients. In perioperative cancer surgery patients with categorical comparisons of any versus no RBC transfusion, increased risk of VTE with RBC transfusion was found in 11 of 31 studies, 5 by univariate correlation only and 6 in multivariate analysis. All six multivariate-positive studies had intermediate overall rates of thrombosis (1.4–6.0%), and three were in urological surgery series. In the larger studies of > 2,000 patients (range: 2,219–44,656), the maximum odds ratio among the multivariate-positive studies was 1.3. Perioperative RBC transfusion volume was more strongly associated with VTE risk, with a positive association in six of seven studies. One large registry-based study of hospitalized cancer patients, not restricted to the perioperative setting, found an adjusted odds ratio of 1.60 (95% confidence interval: 1.53–1.67) for VTE risk in patients receiving RBCs compared with nontransfused patients.

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CURRENT TREATMENT OPTIONS FOR ANEMIA IN PREGNANT WOMEN (LECTURE)

Medical Council ◽

10.21518/2079-701x-2017-2-26-30 ◽

2017 ◽

pp. 26-30

Author(s):

V. M. Chernov ◽

I. S. Tarasova

Keyword(s):

Blood Cell ◽

Pregnant Women ◽

Red Blood Cell ◽

Intravenous Iron ◽

Oral Iron ◽

Iron Sucrose ◽

Deficiency Anemia ◽

Ferric Carboxymaltose ◽

Lactation Period ◽

Red Blood Cell Transfusions

Anemia can be detected in women before pregnancy, during pregnancy, after childbirth, during lactation period, requiring the attention of doctors and clinical and laboratory monitoring. Iron deficiency anemia (IDA) is the most common anemia in pregnant women. Accurate diagnosis is needed, since there are other possible anemias (posthemorrhagic, folate deficiency, anemia of chronic diseases). Modern options of IDA treatment are include the use of oral iron preparations (in 90% of pregnant women), intravenous iron preparations (in 10% of pregnant women), erythropoiesis stimulating agents – ESA (in 2% of pregnant women), and red blood cell transfusions in severe cases (in 3% of pregnant women). The history of creation of intravenous iron complexes in the laboratory of C.F. Hausmann, as well as properties of various intravenous iron complex formulations in the historical aspect of their manufacturing process (ferric gluconate, iron dextran, iron sucrose, ferric carboxymaltose) and the negotiation of adverse events are described. Indications for the use of intravenous iron preparations are the following: severe IDA, ineffectiveness or intolerance of oral iron, the presence of gastric or duodenal ulcer or gastrointestinal surgery in the past, contraindications for red blood cell transfusions, use of ESA. The advantages of intravenous ferric carboxymaltose are the possibility to use the high dose of iron preparation (1000 mg, 1 time per week), no need for test dose, the possibility of intravenous administration in 15 minutes. High efficiency, good tolerability of ferric carboxymaltose in the treatment of IDA are shown. Pharmacoeconomic analysis showed the feasibility of administration of ferric carboxymaltose in comparison with the drug of previous generation (iron sucrose). The use of intravenous iron preparations in the treatment of IDA in pregnant women will allow to minimize red blood cell transfusions and to move to the stage of drug replacement therapy.

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