Red blood cell transfusion thresholds in acute leukemia: Current practice and physician perspectives from a national survey.

backgroundRed blood cell (RBC) transfusions are part of essential supportive therapy in patients with acute leukemia, where patients often present with anemia and thrombocytopenia. Together these cytopenias increase bleeding risk; however, optimal hemoglobin (Hb) thresholds for RBC transfusion remain undefined, and current recommendations for restrictive strategies (<7 g/dL) are based on low-certainty, indirect evidence. STUDY DESIGN AND

methodsA national web-based survey was distributed to 43 physicians (24 centers, Canada) to assess current RBC transfusion practice in patients with acute leukemia, perceptions of a liberal threshold (11 g/dL) in the context of a clinical trial, and feasibility considerations. The survey included categorical responses and open-text fields.

resultsOf 38 eligible physicians, 34 responded (89%). For stable, non-bleeding patients receiving induction chemotherapy, 27/34 (79%) used a Hb threshold of 7 g/dL, 6/34 (18%) used 8 g/dL, and 1/34 (3%) used 9 g/dL. Fourteen (14/34, 41%) respondents indicated that a Hb threshold of 11 g/dL was reasonable for the liberal arm of a clinical trial, while 20/34 (59%) did not. For such a trial, 32/34 (94%) would consider enrolling patients in the trial and 2/34 (6%) would not. DISCUSSION: A Hb threshold of 7 g/dL was most reported as standard-of-care. Most respondents supported enrolling their patients in a clinical trial comparing a liberal RBC transfusion strategy of 11 g/dL with standard-of-care. The feasibility of 11 g/dL should be tested with clear justification, appropriate study outcomes, and attention to safety risks and resource demands.