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Transfusion thresholds for cancer patients

Transfusion thresholds for cancer patients. Frédéric Pène Medical ICU, Hôpital Cochin, AP-HP, Paris University Paris Descartes Institut Cochin, Inserm U1016, CNRS UMR-8104. No conflict of interest. Does research about transfusion thresholds in critically ill OH patients remain relevant ?.

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Transfusion thresholds for cancer patients

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  1. Transfusion thresholds for cancer patients Frédéric Pène Medical ICU, Hôpital Cochin, AP-HP, Paris University Paris Descartes Institut Cochin, Inserm U1016, CNRS UMR-8104

  2. No conflict of interest

  3. Does research about transfusion thresholds in critically ill OH patients remain relevant ? • Blood products are limited and expensive resources • Blood products are associated with side effects • OH patients are high consumers of blood products • Cytopenia are most often already present at ICU admission • Translation from studies in general ICU population or stable OH patients to critically ill OH patients is questionable • High risk of death and ICU-acquired complications • Infections • Bleeding • Few but discrepant studies in the field

  4. Number of packed RBC 2.6 ± 4.1 p<0.01 5.6 ± 5.3 Hb > 7 g/dL Hb > 10 g/dL

  5. NEJM 2014

  6. Park, Crit Care Med 2012 Mortality in septic pts

  7. RBC transfusions for early sepsis resuscitation in hemato patients No transfusion Mortality : - D7 : 13.3% vs. 20.5% p = 0,02 - ICU : 25.2% vs. 39% p < 0.001 - Hosp. : 36.6% vs. 49% p < 0.001 Cumulated survival Transfusion Days Mirouse A. for the Grrr-OH, Réanimation congress 2016

  8. Holst, N Engl J Med 2014

  9. RBC transfusion in OH patients with septic shock: the randomized studies

  10. Designing future studies in the field • Still a relevant question? • Restricting vs. promoting RBC transfusions? • Chronic vs. ICU-acquired anemia • Multicenter studies • Should transfusion indications be hemoglobin-based only? • Relevant endpoints? • Mortality (short-term & long-term) • Alternative endpoints • Clinical deterioration/improvement • ICU-acquired complications (infectious and non-infectious)

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