Is there a standard-of-care for transfusion support of patients with haematological malignancies?

Patients with haematological malignancies are a high-user group for blood transfusions. Here, we describe the current evidence on transfusion policies in patients with haematological malignancies, based on recent systematic reviews of RCTs.

Results from six RCTs (1195 participants) suggest that prophylactic platelet transfusions reduce bleeding compared with therapeutic-only use, although the effects varied according to patient diagnosis/treatment plan. A meta-analysis of seven RCTs (1814 participants) reported that low-dose platelet transfusions (1.1 × 10/m ± 25%) were noninferior to standard dose (2.2 × 10/m ± 25%), or high dose (4.4 × 10/m ± 25%). Three RCTs (499 participants) reported that restrictive platelet count thresholds (less than 10 × 10/l) were noninferior to liberal thresholds counts (less than 20-30 × 10/l). For red-cell transfusions, the data from completed RCTs was less advanced. A recent meta-analysis with four RCTs (240 participants) suggested that restrictive thresholds (less than 70-90 g/l) are noninferior to liberal thresholds (less than 80-120 g/l), but with more uncertainty for clinical outcomes.

There is support from randomised trials for using prophylactic platelet transfusions, in low-dose, and with restrictive thresholds. No large completed studies have been published for red-cell transfusions. Many studies overall were arguably underpowered and only offered low-to-medium grade level evidence.