Blood is a living tissue composed of specific structures, each with distinct functions. Blood
transfusion is a tissue or even organ transplantation. Unnecessary blood transfusion should
not be done, and the missing component should be replaced in the patient.
The need for transfusion seen in medical diseases is often in the form of chronic anemia,
except for a few conditions that cause sudden bleeding. Repeated transfusions may be required
in these patients during the course of their disease and related problems may arise. For this
reason, while determining the indication for transfusion, it is absolutely necessary to
perform the benefit-harm analysis correctly.
The main purpose of approaching the anemic patient is to provide and maintain hemoglobin
levels that will allow oxygen to reach the tissue at an adequate level. This critical level
may vary from patient to patient, the age of the patient and other accompanying diseases are
among the determining factors. The most important factor in transfusion indication is the
insufficiency of cardiopulmonary compensation mechanisms due to anemia in the patient and the
patient becoming symptomatic. Red blood cell (RBC) transfusions are common in the treatment
of cancer patients.
Generally, patients with oncological and hematological malignancies use approximately 34% of
the RBC source. In cancer patients, similar to other patient populations, the indication for
RBC transfusion is to alleviate anemia, which is actually symptomatic. However, the decision
to transfuse should not be guided solely by the hemoglobin concentration. No single criterion
can be used as an indicator of RBC transfusion.
The clinical condition of the patient must be taken into account. Anemia can be seen in
approximately 90% of patients during chemotherapy treatment. Cytotoxic drugs often cause the
loss, destruction and reduction of RBCs that cause anemia. Especially lung and gynecological
cancers are highly associated with anemia. Platinum-based chemotherapeutics are often
preferred in the treatment of such cancers. Anemia in cancer can reduce quality of life and
increase cancer-related fatigue and may be a poor indicator of clinical outcomes. That is
why, in clinical practice, transfusions are often performed in cancer patients.
In general, a hemoglobin level of 7 g / dL is a suitable indicator for red blood cell (RBC)
transfusion in stable patients without complications. However, patients with cardiovascular
disease or acute coronary syndrome can be transfused at a hemoglobin level of 8 g / dL.
Although the indications for transfusion in patients with other types of complications are
unclear, cancer patients have reported improved clinical well-being when kept at about 7 g /
dL in hemoglobin levels, but no study results suggested an absolute hemoglobin level that is
optimal for patients with cancer.
With this study, it is aimed to develop clinical practices to prevent unnecessary transfusion
practices in lung cancer patients, to encourage the application of other supportive treatment
options, and to take preventive measures before anemia develops.
Patients who have been followed up and receiving chemotherapy in our chest diseases
department in the last 5 years will be included in our study. Patients who were diagnosed
with lung cancer between 01/01 / 2014-31 / 12/2018, followed up in the chest diseases service
and given chemotherapy will be included in the study. Patient data will be retrospectively
collected using file records and hospital automation system (clinical course, blood bank
data, consultation records, etc.). The study will begin after the approval of the ethics
committee and will continue for 6 months.
Exclusion Criteria; Patients with known hematological malignancies other than lung cancer,
patients who were diagnosed with anemia before chemotherapy treatment, who received treatment
for this reason, patients who were diagnosed with lung cancer in our clinic but did not
continue chemotherapy treatment in our clinic afterwards, and patients who are thought to
impair data integrity due to incomplete data will be excluded from the study.
Patients' data to be followed; Exclusion Criteria; Patients with known hematological
malignancies other than lung cancer, patients who were diagnosed with anemia before
chemotherapy treatment, who received treatment for this reason, patients who were diagnosed
with lung cancer in our clinic but did not continue chemotherapy treatment in our clinic
afterwards, and patients who are thought to impair data integrity due to incomplete data will
be excluded from the study.
Patients' data to be followed; Demographic characteristics, comorbid diseases, cancer type
and stage, how long it was followed up with this diagnosis, Hb value before starting
chemotherapy, whether RBC transfusion was performed during the follow-up period, which Hb
value of blood transfusion was applied, how many units of RBC or other blood were taken
during the follow-up period. product replacement, how many cures of chemotherapy they
received in total, which chemotherapy drugs they took, whether there was a delay in treatment
due to treatment-related anemia, the most frequent indications and complications of
transfusion (allergic reaction, febrilereax., infection and thromboembolic complications),
whether they received additional radiotherapy. , whether they received GMC-SF due to anemia,
blood groups, survival times, how many times there was cancer progression under treatment,
and if there is distant metastasis, the location of metastasis was aimed to be screened.
In the analysis of the data; The compliance of the data to normal distribution will be
examined by Shapiro Wilk and Kolmogorog Smirnov tests. Kruskall-Wallis, Mann-Whitney U,
student-t and chi-square tests will be used for comparisons between groups. General linner
modeling, Wilcowon and Friedman tests will be used in serially tracked data. Data will be
given as percentage, mean (std deviation) and median (minimum-maximum). The chi-square test
will be used to compare qualitative data. Categorical data will be presented in the form of
frequency and percentage.