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

8. NEJM 2014

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

10. 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

11. Holst, N Engl J Med 2014

14. RBC transfusion in OH patients with septic shock: the randomized studies
Rygard, AAS 2016
Bergamin, CCM 2017
Number of patients
170
300
Setting
Multicenter (Scandinavia)
Single-center (Brazil)
Inclusion criteria
Septic shock & Hb<9 g/dL
Septic shock
Main exclusion criteria
Prior transfusion in the ICU
Hematological malignancies
Underlying diseases
75 HM + 95 metastatic cancer
300 solid tumors
SOFA
HM 11 (9-14) vs. 11 (9-15)
Cancer 10 (9-12) vs. 10 (8-12)
7 (5-9) vs. 6 (5-9)
Transfusion strategies
7 vs. 9 g/dL (ICU stay)
% transfused
HM 69% vs. 100%
Cancer 57 vs. 98%
41% and 61%
Number of packed RBC
HM 2 (0-7) vs. 5 (2-10)
MC 1 (0-3) vs. 3 (2-5)
0 (0-2) vs. 1 (0-3)
Mortality at day 90
HM 62% vs. 56% (ns)
Cancer 60 vs. 55% (ns)
70% vs. 59%, p=0,03

16. 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)