[Transfusions in myelodysplastic syndromes]

PRBC transfusion remains the mainstay of treatment of anemia in MDS after failure of erythropoiesis stimulating agents. The most common transfusion trigger in transfusion-dependent MDS patients is 80g/L. This level is based only on expert consensus; a randomized controlled trial comparing restrictive against liberal policy is required to evaluate potential impact of transfusion policy on with QoL and survival. Prophylactic antigen matching for RhCE and K must be used in order to reduce the risk of red blood cell (RBC) alloimmunization. Transfusion associated circulatory overload (TACO) is the first fatal complication of transfusion in MDS patients. Prevention, in this high risk group (older people with cardiac comorbidities) requires slow transfusion rates and rigorous monitoring of systolic blood pressure. Long-term transfusion in low risk MDS patients could also induce iron overload complications that could be prevent by iron chelating agents. These latter are usually not very well tolerated, however, a new formulation of Deferasirox^® seems to be able to improve patient satisfaction.