Clinical Utility of Multiple Blood Transfusion Products and the Management of Hematological Complications, Implications and Preventive Strategies among Oncological Patients: A Systematic Review
Jacques Forwah Ndeh *
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Ewa Anthony Obi
Department of Family Medicine, University of Calabar Teaching Hospital Calabar, Cross River State, Nigeria.
Edung Emen Samuel
Emergency Department, Basildon and Thurock University Hospital London NHS Trust Foundation, United Kingdom.
Oluwagbenga Emmanuel Fatoba
Department of General Surgery, Cedar Park Healthcare, NHS Lincoln, England.
Catherine Samuel Edung
Department of Clinical Microbiology, Cerba Lamcet Africa Lagos, Lagos State, Nigeria.
Eze Godspower
Emergency Medicine Department, Royal Derby Hospital Rotherham, United Kingdom.
Ohadiugha Uchenna Peter
Department of Emergency Medicine Nizamiye Hospital, Abuja, Nigeria.
Otonko Bernardine Osarr
Department of Clinic, National Defence College, Abuja, Nigeria.
Emefuru Juliet Adaku
Department of Internal Medicine, Lagos State Health Service Commission Lagos, Nigeria.
Ukpabi Chiemerie
Department of Internal Medicine & Paediatrics, Save a Child’s Brain Neurological Consultants Limited, Abia, Nigeria.
Portia Nomfundo Mzezewa
Department of Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, United Kingdom.
Habiba Abdulkadir
Department Primary Health Care Board Lagos, Lagos State, Nigeria.
Ezinne Regina Okeoma
University of Nigeria, Epsom, United Kingdom.
Chiamaka Nnenna Ukpabi
Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Ovia Stanley Chibueze
Department of General Practice (GP), Christian Health Association of Nigeria Abuja, Federal Capital Territory, Nigeria.
Chinonso Chimelu Ezeobi-Chris
Department Public Health, National AIDS/STIs and Viral Hepatitis Control Program, Abakaliki, Nigeria.
Adeniran Adebayo Emmanuel
Department of Trauma and Orthopaedic, Obafemi Awolowo University, Ile Ife, Nigeria.
I. Kehinde Oluwagbeminiyi
Department of Obstetrics and Gynaecology, University of Medical Sciences Teaching Hospital, Akure, Nigeria.
Oliver X. Otu
Department of Surgery, Circle Health Group, Darlington, United Kingdom.
Ike-Ogbonna Ginikachi Valerie
Department of Obstetrics & Gynaecology, Abuja, Nigeria.
Blessing Festus Arimie
Department of Psychiatry, NES Healthcare Peterborough, United Kingdom.
Okpara Camillus Chinweike
Department of Surgery, ESUTH, PARKL ANR, Brisol, United Kingdom.
Idiege Idiege Omang
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Immaculate Ihuoma Ekeagba
WORCACCCE UNION GROUP Integrated Healthcare Sciences, Technological Development and Training and Innovative Research Foundation (WUGIHSTTAIRF), P.O Box 45 Bamenda, North West Region, Cameroon.
Abeshi Sylvester Etenikang
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Patients with solid tumors and hematological malignancies frequently develop transfusion-dependent anemia from marrow infiltration and cytotoxic therapy. Multiple blood transfusions (MBT) sustain oxygen delivery but increase alloimmunization, iron overload, transfusion-related immunomodulation (TRIM), and thrombosis/bleeding shifts. Practice variation persists on haemoglobin (Hb) triggers, component ratios, and mitigation (phenotyping, chelation).
Objective: To critically appraise the clinical utility of MBT in oncological populations and synthesize hematological implications (alloimmunization, iron metrics, TRIM, survival) and formulate the best management strategies for Haematological complications and prevention.
Methodology: PRISMA-guided critical review (2010–2025).
Search engines (10): PubMed/MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, African Index Medicus, IMEMR, LILACS, WHO Global Index Medicus, Google Scholar were used.
Search terms (sample): ("multiple blood transfusion" OR "repeated transfusion" OR "chronic transfusion") and (oncology OR cancer OR leukaemi OR lymphoma) AND (alloimmun_ OR "iron overload" OR ferritin OR TRIM OR thrombosis OR "hemoglobin trigger")—adapted per engine (MeSH/Emtree; title/abstract).
Selection:350 records → 240 studies included (adult oncology; ≥2 transfusion episodes; report Hb thresholds, alloantibodies, ferritin/MRI iron, Venous Thromboembolism (VTE) occurrence is independently associated with shorter Overall Survival (OS) and Progression-Free Survival (OS/PFS). Appraised via SANRA & Newcastle–Ottawa; thematic synthesis by tumour type/intent.
Results: 240 studies (n≈102,400) and restrictive Hb (70–80 g/L) non-inferior in solid tumours; liberal use retained in Acute Myeloid Leukemia (AML)/Myelodysplastic Syndromes (MDS) induction. Alloimmunization: 14–26% after ≥10 units (↓ ∼38% with leukoreduced & Rh/Kell matching). Iron overload (ferritin>1000 µg/L) in 28% after ≥20 units, associated with higher non-relapse mortality post-HSCT. Transfusion Related Immunomodulation signal bacterial sepsis (RR≈1.18); RBC:plasma >1.5 modestly raised Venous Thromboembolism(VTE).
Main Finding: Management of blood transfusion (MBT) are life-saving in acute settings but show diminishing hematological utility beyond ∼10–12 episodes without Patient Blood Managenent /chelation; alloimmunization and iron loading drive late morbidity more than incremental Hb gain.
Conclusion: Restrictive strategies, extended phenotyping, and early iron monitoring optimize utility. Routine liberal Management of blood transfusion in stable oncology patients is not supported; Curative-intent subgroups often require personalized approaches because patients' responses to treatment can vary widely. Tailored thresholds help identify the most effective treatment strategies for specific groups. Factors influencing these thresholds include: Biomarker profiles, Cancer stage and aggressiveness, Patient overall health and Genetic factors.
Keywords: Oncology, multiple blood transfusion, alloimmunization, iron overload, TRIM, patient blood management