Evaluation of Alternative Transfusion Triggers in Hemodynamically Stable, Non-Ventilated Cancer Patients

Evaluation of Alternative Transfusion Triggers in Hemodynamically Stable, Non-Ventilated Cancer Patients: A Prospective Observational Study

This is a prospective, single-center observational study conducted at the Kazakh Institute of Oncology and Radiology. The study included 107 clinically stable adult patients with cancer who required red blood cell transfusion based on a restrictive hemoglobin threshold. The aim of the study was to evaluate alternative physiological indicators of transfusion need and effectiveness. Measurements included oxygen extraction ratio (O₂ER), central venous oxygen saturation (ScvO₂), partial pressure of oxygen in central venous blood (PvO₂), arterio-venous oxygen difference (A-VO₂diff), lactate, and veno-arterial carbon dioxide difference (ΔCO₂). These parameters were assessed before and one hour after transfusion. For data analysis, patients were stratified into two groups based on their baseline O₂ER (≤35.4% and >35.4%) to evaluate whether higher O₂ER is associated with more pronounced physiological response to transfusion.

Study Overview

• Status: Completed
• Conditions: Cancer; Anemia; Blood Transfusion; Hemoglobin; Alternative Physiological Transfusion Triggers
• Intervention / Treatment: Procedure: Red blood cell transfusion

• Study Type: Observational
• Enrollment (Actual): 107

Contacts and Locations

Study Locations

• Kazakhstan
  • Almaty, Kazakhstan, 050000
    • Kazakh Institute of Oncology and Radiology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Clinically stable, non-ventilated adult oncology patients with anemia who required red blood cell transfusion as part of routine clinical care at the Kazakh Institute of Oncology and Radiology.

Description

Inclusion Criteria:

• Adult cancer patients (age 18 years or older)
• Hemodynamically stable
• Not requiring any form of respiratory support
• Presence of a central venous catheter inserted into the superior vena cava

Exclusion Criteria:

• Hemodynamic instability requiring inotropic or vasopressor support
• Active bleeding
• Shock of any etiology
• Patient refusal to participate in the study
• Hematological malignancies
• Age under 18 years
• Pregnancy

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Cancer Patients with Anemia Receiving RBC Transfusion; This group includes clinically stable, non-ventilated adult oncology patients with anemia who received red blood cell transfusion at the Kazakh Institute of Oncology and Radiology. All participants were monitored for physiological parameters-including O₂ER, ScvO₂, PvO₂, A-VO₂diff, lactate, and ΔCO₂-before and one hour after transfusion.	Procedure: Red blood cell transfusion; Standard red blood cell transfusion performed as part of routine clinical care. All participants received one or more units of RBCs based on a restrictive hemoglobin threshold. The transfusion protocol was not altered for the purpose of the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Oxygen Extraction Ratio (O₂ER)	Difference in oxygen extraction ratio measured before and one hour after red blood cell transfusion	Baseline and 1 hour post-transfusion

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Partial Pressure of Oxygen in Central Venous Blood (PvO₂)	Difference in PvO₂ measured before and one hour after transfusion	Baseline and 1 hour post-transfusion
Change in Central Venous Oxygen Saturation (ScvO₂)	Difference in ScvO₂ measured before and one hour after transfusion	Baseline and 1 hour post-transfusion
Change in Lactate Concentration	Difference in serum lactate measured before and one hour after transfusion	Baseline and 1 hour post-transfusion
Change in Arterio-Venous Oxygen Difference (A-VO₂diff)	Difference in arteriovenous oxygen difference measured before and one hour after transfusion	Baseline and 1 hour post-transfusion
Change in Veno-Arterial Carbon Dioxide Difference (ΔCO₂)	Difference in ΔCO₂ measured before and one hour after transfusion	Baseline and 1 hour post-transfusion

Collaborators and Investigators

• Sponsor: Ardak Arynov
• Investigators: Principal Investigator: ARDAK A ARYNOV, M.D., Department of Anesthesiology and Intensive Care, Kazakh Institute of Oncology and Radiology, Almaty city, Kazakhstan; Study Chair: Evgeni Brotfain, M.D., Professor, Division of Anesthesia and Critical Care, Director of Post Anesthesia Care Unit, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel

Study record dates

Study Major Dates

• Study Start (Actual): March 8, 2019
• Primary Completion (Actual): November 24, 2021
• Study Completion (Actual): November 24, 2021

Study Registration Dates

• First Submitted: April 23, 2025
• First Submitted That Met QC Criteria: April 23, 2025
• First Posted (Actual): April 30, 2025

Study Record Updates

• Last Update Posted (Actual): May 21, 2025
• Last Update Submitted That Met QC Criteria: May 16, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: anemia; red blood cell transfusion; central venous oxygen saturation; oxygen extraction ratio; physiologic transfusion trigger; alternative transfusion trigger
• Additional Relevant MeSH Terms: Hematologic Diseases; Anemia
• Other Study ID Numbers: KazIOR-ALTTRANS-2019

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The study results will be published in aggregated form only. No individual participant data (IPD) will be shared.