Clinical Utility of Multiple Blood Transfusion Products and the Management of Hematological Complications, Implications and Preventive Strategies among Oncological Patients: A Systematic Review

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.