Thread by @TransfusionWM

Next up @SimonStanworth on red cell transfusion in MDS.
A registry in S Australia showe cumulative incidence of alloimmunisation of 11% and these patients went on to increase their transfusion requirement
haematologica.org/content/early/…

Recent NCA in UK shows that a third of transfusions in haematology go to patients with MDS. Average threshold used across the country is approx 80 g/L #BSH2019

But what is the evidence to guide when to transfuse in MDS? Plenty of thresholds studies in non haematology patients but very little data to date in MDS and/or those with chronic anaemia #BSH2019

In thresholds studies restrictive thresholds generally shown to be non inferior. But how applicable are these to chronic anaemia or bone marrow failure? #BSH2019

TRIST study in HSCT patients is yet to be published but presented at ASH. Restrictive did not appear to be detrimental to QOL #BSH2019
bloodjournal.org/content/128/22…

Some evidence that we may need to be more cautious in those with cardiac disease. But how to define cardiac disease? These patients also at more risk of TACO #BSH2019

REDDS-1 is a feasibility study - thresholds have not been studied in an outpatient population previously. Thresholds of 85-100 vs 110-125 g/L #BSH2019

Is it average hb that matters or do swings in hb influence QOL? Previous data suggest lower amplitudes are associated with better QOL #BSH2019
sciencedirect.com/science/articl…

Feasibility data show good compliance and significant difference between the pre transfusion hb in the two arms. Compliance with QOL assessment 70-80% #BSH2019

Near doubling of red cells required to maintain the hb in the liberal arm. Transfusions also required more frequently; would have resource implications as well as for QOL #BSH2019

REDDS was a blinded study and less than a third of patients correctly guessed their treatment arm #BSH2019

Patients were followed for 3 months so not possible to draw conclusions on implications of iron handling #BSH2019

Prof Stanworth quite rightly makes the point that patient blood management is NOT about not giving transfusions. It’s about making the right decisions for the right patients and giving them the treatment that is best for them #BSH2019