AM24-ST-05-O: RBC Transfusions for Patients with Hematologic Conditions: Hemoglobin Thresholds, Iron Metabolism (Enduring)

Patients with marrow suppression and hypoproliferative anemia represent a challenge for red blood cell transfusions. Iron overload affects the health and quality of life of patients with chronic transfusion needs and patients with primary defects on iron metabolism. In general, patients receiving more than 10 or 20 red blood cell transfusions are at significant risk of developing iron overload. In addition, iron metabolism is disrupted by chemotherapy or hematopoietic cell transplantation used to treat acute leukemias and myelodysplastic syndromes, contributing to the risk of transfusion-related iron overload. Red blood cell transfusion is not without risks and should be used when benefits outweigh the risks. The recent 2023 AABB International RBC guidelines recommended for the first time, a restrictive transfusion threshold for this patient population. Since the 2016 AABB RBC guidelines, several clinical trials evaluating transfusion thresholds in this population were completed, and new evidence became available. Outcomes such as bleeding, exposure to blood and quality of life are of particular importance in patients with marrow suppression and cancer. The purpose of this session is to discuss the effects of transfusion on iron metabolism and outcomes in patients with hematologic/oncologic conditions. We will also review the diagnostic tools, preventive strategies and treatment options for iron overload, and well as the new evidence evaluating hemoglobin thresholds that influence transfusion burden, so the audience can inform their transfusion decisions.