Prevention of blood transfusions in oncologic surgery

The central theme of the studies presented in this dissertation is: prevention of blood transfusions in oncologic surgery and the consequences of such therapy. The first 3 Chapters of this dissertation, are an introduction to the two experimental parts. Chapter 1 summarizes the risks associated with blood transfusions, with emphasis on their immune-suppressive action and Chapter 2 discusses the process of erythropoiesis after acute blood loss. The purpose and design of the two clinical studies is expounded in Chapter 3. In the "Autologous Blood Transfusion Trial", patients were randomized for autologous or allogeneic blood transfusion therapy during surgery. The patients randomized for autologous blood transfusions donated 2 units of blood, 14 and 10 days before surgery. In the "EPO trial" patients were randomized for perioperative treatment with recombinant Human Erythropoietin (r-HuEpo) or no treatment. In vitro immunologic studies were conducted in both patients groups, in patients with a metastazised carcinoma and in healthy blood donors. The results are of these immunologic studies are given in the first experimental part (Chapters 4-6), which deal with the effect of cancer, blood donation, surgery and blood transfusion upon the immune system and upon tumor growth. In the second experimental part (Chapter 7-10) the results of two techniques to prevent blood transfusions in cancer patients are discussed: 1) pre-operative autologous blood donation, and 2) treatment with r-HuEpo.