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Determinants of intertransfusion interval in children with transfusion-dependent thalassemia: a retrospective
Ji-Hua Ma1, Ming-Wei Yin1, Xue-Jun Chen1
1Department of Blood Transfusion, Children's Hospital, Zhejiang University School of Medicine, National Children's Regional Medical Center, National Clinical Research Center for Child Health, Hangzhou, China.
Insights
Genotype severity and red blood cell product type significantly impact transfusion intervals in pediatric transfusion-dependent thalassemia (TDT). Personalized transfusion strategies can optimize treatment and reduce complications for these young patients.
Area of Science:
- Pediatric Hematology
- Transfusion Medicine
- Thalassemia Research
Background:
- Optimizing blood transfusion regimens is critical for managing children with transfusion-dependent thalassemia (TDT).
- Identifying factors influencing transfusion intervals is essential for improving patient care and treatment efficacy.
Purpose of the Study:
- To determine the key factors affecting intertransfusion intervals in pediatric patients with TDT.
- To analyze the impact of patient demographics, genotype, and red blood cell (RBC) product characteristics on transfusion frequency.
Main Methods:
- A retrospective observational study of 21 pediatric β-thalassemia patients and 392 transfusions.
- Analysis included univariate tests, correlation analysis, and binary logistic regression to identify determinants of intertransfusion intervals.
- Multivariable linear regression evaluated factors influencing pre-transfusion hemoglobin levels.
Main Results:
- Genotype severity (major vs. minor) and RBC product type (leukocyte-reduced RBC vs. washed RBC) independently influenced intertransfusion intervals.
- Age and weight negatively correlated with intertransfusion intervals.
- Patients with major genotypes had significantly lower pre-transfusion hemoglobin levels; leukocyte-reduced RBCs showed a hemoglobin advantage over washed RBCs.
Conclusions:
- Genotype severity and RBC product type are significant determinants of intertransfusion intervals in pediatric TDT.
- Personalized transfusion strategies considering these factors are recommended for optimizing efficacy and minimizing complications.
- Adverse reactions, including febrile reactions and alloimmunization, were observed in 23.8% of patients.
Background:
Optimizing transfusion regimens is crucial for children with transfusion-dependent thalassemia (TDT). This study aimed to identify the determinants of intertransfusion intervals to address this need.
Methods:
This single-center retrospective observational study included 21 pediatric β-thalassemia patients with 392 transfusions. Transfusions were grouped by median interval (18 days). The associations between intertransfusion intervals and demographics, genotype, red blood cells (RBC) product characteristics, as well as transfusion adequacy were analyzed using univariate tests and correlation analysis. Binary logistic regression was used to identify the independent determinants of intertransfusion intervals, and then multivariable linear regression was constructed to evaluate the factors influencing hemoglobin levels before the subsequent transfusion.
Results:
Genotype severity [major vs. minor, odds ratio (OR) =0.397, P=0.03] and RBC product type [leukocyte-reduced RBC (LRBC) vs. washed RBC (WRBC), OR =0.378, P=0.007] independently influenced intertransfusion intervals. Age and weight correlated negatively with intertransfusion intervals (r =-0.341 and -0.298, P<0.001). Patients with a major genotype exhibited a markedly decreased of 8.428 g/L (P<0.001) in the hemoglobin level before the subsequent transfusion, while the intermediate genotype showed a moderate reduction of 5.534 g/L (P=0.01), relative to the minor genotype reference. LRBC transfusions were associated with a significant hemoglobin advantage, demonstrating a 2.681 g/L elevation (P=0.049) compared to WRBC transfusions, administered as 1-unit protocols. Adverse reactions occurred in 5/21 patients (23.8%), which included febrile reactions and alloimmunization.
Conclusions:
Genotype severity and RBC product type significantly affect intertransfusion intervals in pediatric TDT. Personalized strategies considering these factors may optimize transfusion efficacy and reduce complications.
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