Liberal versus restrictive red blood cell transfusion in oncology practice: a systematic review

Background The optimal strategy for red blood cell transfusion in the context of oncology continues to be a contentious issue. This systematic review aims to critically analyze the comparative safety and efficacy of liberal versus restrictive transfusion protocols within various subpopulations of oncology patients globally. Patients and methods A comprehensive search of the literature from 2014 to 2023 was conducted utilizing databases such as PubMed, Google Scholar, Cochrane Library, SciSpace, and Directory of Open Access Journals. Eligible studies comprised both randomized and nonrandomized clinical trials that examined transfusion thresholds among a variety of oncology patients undergoing chemotherapy, radiotherapy, surgical interventions, or palliative care. The assessment of risk of bias was performed employing the Cochrane Risk of Bias 2 and Newcastle-Ottawa scales. Results A total of six studies, encompassing 6,630 participants, fulfilled the inclusion criteria. Restrictive transfusion strategies (with hemoglobin thresholds of 7–8 g/dl) were associated with decreased transfusion rates and postoperative complications, without a concomitant increase in mortality or morbidity. Several studies indicated a possible trend toward enhanced outcomes with restrictive strategies, particularly in patients with hematologic malignancies. Conclusion Restrictive red blood cell transfusion strategies appear to be both safe and effective for stable oncology patients, potentially mitigating complications and conserving medical resources. The necessity for individualized transfusion decisions remains paramount.