Erythrocyte and platelet transfusion applications in pediatric haematology and oncology patients and investigation of their effects on clinical progress

Aim: In pediatric haematology and oncology patients, supportive treatments have vital importance besides the treatment intended to cancer. In this sense; transfusion is one of the supportive treatments which are used in daily practice very often and irrevocable in cancer patients. On the other hand, thresholds for transfusion in cancer patients are not well known although they are used very often and because of this; they do not have consistency. Furthermore, it is not well known that how much the effects can be stemmed from transfusion are influential in long term survival and disease progress yet. We aimed to specify the frequency and thresholds of erythrocyte and platelet transfusions which are administered to pediatric haematology and oncology patients and research the effects of transfusions on the clinical progress and transfusion complications. We believe that our research will contribute to literature not only by defining the thresholds of erythrocyte and platelet transfusions but also by researching the effect of frequency of transfusions on clinical progress. Materials and Methods: Eighty leukaemia and 173 lymphoma and solid tumour diagnosed patients who have been diagnosed with cancer in Dokuz Eylul University Pediatric Haematology and Oncology Department between the 1st of January, 2013 and 1st of January, 2018 and have been transfused with erythrocyte and/or platelet suspension at least for one time period in the course of their treatments are involved to our research. The data of the patients are scanned by clinical follow-up files, blood bank records and Probel information system as retrospective. Demographical characteristics, dates of presentation and diagnosis, treatments, dates of beginning and end of treatments, total transfusion numbers, transfusion numbers according to treatment steps, the number of infection episodes and the last follow-up situations of each patient are cleared. Pretransfusion haemoglobin (Hb) and platelet levels are addressed on the basis of each patient and recorded to the patient data file. The data are analyzed with IBM ® SPSS ® 25 programme. Results: Leukemia diagnosed 80 (31,6%) patients and 173 (68,4%) lymphoma or solid tumour diagnosed patients are involved in our research. Totally 1389 units of erythrocyte suspension (ES) and 1357 units of platelet suspension (PS) were administered to leukaemia group; 1604 units of erythrocyte suspension and 1243 units of platelet suspension were administered to lymphoma and solid tumour group. A significant difference was detected between leukaemia and solid tumour groups in terms of ES and PS transfusions; as the leukaemia group had more transfusions (p<0.001). Pretransfusion mean Hb was 7,3±0,69 (6,2-11,7) g/d L and median Hb was 7,4 (7,2-7,5) g/dL, pretransfusion platelet was 22,8±6,95 (10,5-53,3) x103/mm3, median platelet was 19,8 (16-22) x103/mm3 in leukemia diagnosed patients. In lymphoma and solid tumor diagnosed patients pretransfusion Hb was 8,2±1,21 (5-13,9) g/dL, median Hb was 8,2 (7,6-8,3) g/dL; pretransfusion mean platelet was 30±30,86 (4,3-260) x103/mm3 and median platelet was 25,5 (19-28) x103/mm3. A positive correlation was detected between platelet values at diagnosis and totally PS transfusion numbers of leukaemia patients (p<0.001). There was no relation between Hb value at diagnosis and ES transfusion numbers. In lymphoma and solid tumour patients; the negative correlation was found between Hb levels at diagnosis and ES transfusions (p=0.005). The patients were compared in terms of survival rates as classified according to pretransfusion mean Hb and platelet values. In leukaemia patients; 3-year and 5-year of overall survivals were found shorter in pretransfusion mean Hb >7,5 gr/dl and mean platelet ≥ 30 x103/mm3 groups than mean Hb ≤ 7,5 gr/dl and mean platelet <30 x103/mm3 groups. There was no significant difference in lymphoma and solid tumours as individual groups. Conclusion: As a consequence of this research, total ES and PS transfusion numbers were higher in leukaemia patients in comparison with lymphoma and solid tumours. On the other hand, pretransfusion Hb and platelet thresholds were found higher in lymphoma and solid tumour patients in comparison with the leukemia group. It was detected that some other factors such as diagnosis, risk group and bone marrow infiltration have an effect on transfusion numbers as well. In leukaemia patients with higher pretransfusion thresholds, survival rates were found low; however, studies including more homogeneous and extensive patient groups are needed to demonstrate this connection more clearly. Key Words: Transfusion in pediatric cancer patients, Erythrocyte transfusion, Platelet transfusion, TRIM.