Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 May 23;5(5):CD011305.
doi: 10.1002/14651858.CD011305.pub3.

Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support

Michael Radford  1   2 , Lise J Estcourt  3   4 , Emily Sirotich  5 , Tyler Pitre  6 , Joanne Britto  7 , Megan Watson  6 , Susan J Brunskill  4   8 , Dean A Fergusson  9 , Carolyn Dorée  4   8 , Donald M Arnold  10   11
Affiliations
Meta-Analysis

Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support

Michael Radford et al. Cochrane Database Syst Rev. .

Abstract

Background: An estimated one-quarter to one-half of people diagnosed with haematological malignancies experience anaemia. There are different strategies for red blood cell (RBC) transfusions to treat anaemia. A restrictive transfusion strategy permits a lower haemoglobin (Hb) level whereas a liberal transfusion strategy aims to maintain a higher Hb. The most effective and safest strategy is unknown.

Objectives: To determine the efficacy and safety of restrictive versus liberal RBC transfusion strategies for people diagnosed with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without a haematopoietic stem cell transplant (HSCT).

Search methods: We searched for randomised controlled trials (RCTs) and non-randomised studies (NRS) in MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1982), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2023, Issue 2), and eight other databases (including three trial registries) to 21 March 2023. We also searched grey literature and contacted experts in transfusion for additional trials. There were no language, date or publication status restrictions.

Selection criteria: We included RCTs and prospective NRS that evaluated restrictive versus liberal RBC transfusion strategies in children or adults with malignant haematological disorders receiving intensive chemotherapy or radiotherapy, or both, with or without HSCT.

Data collection and analysis: Two authors independently screened references, full-text reports of potentially relevant studies, extracted data from the studies, and assessed the risk of bias. Any disagreement was discussed and resolved with a third review author. Dichotomous outcomes were presented as a risk ratio (RR) with a 95% confidence interval (CI). Narrative syntheses were used for heterogeneous outcome measures. Review Manager Web was used to meta-analyse the data. Main outcomes of interest included: all-cause mortality at 31 to 100 days, quality of life, number of participants with any bleeding, number of participants with clinically significant bleeding, serious infections, length of hospital admission (days) and hospital readmission at 0 to 3 months. The certainty of the evidence was assessed using GRADE.

Main results: Nine studies met eligibility; eight RCTs and one NRS. Six hundred and forty-four participants were included from six completed RCTs (n = 560) and one completed NRS (n = 84), with two ongoing RCTs consisting of 294 participants (260 adult and 34 paediatric) pending inclusion. Only one completed RCT included children receiving HSCT (n = 6); the other five RCTs only included adults: 239 with acute leukaemia receiving chemotherapy and 315 receiving HSCT (166 allogeneic and 149 autologous). The transfusion threshold ranged from 70 g/L to 80 g/L for restrictive and from 80 g/L to 120 g/L for liberal strategies. Effects were reported in the summary of findings tables only for the trials that included adults to reduce indirectness due to the limited evidence contributed by the prematurely terminated paediatric trial. Evidence from RCTs Overall, there may be little to no difference in the number of participants who die within 31 to 100 days using a restrictive compared to a liberal transfusion strategy, but the evidence is very uncertain (three studies; 451 participants; RR 1.00, 95% CI 0.27 to 3.70, P=0.99; very low-certainty evidence). There may be little to no difference in quality of life at 0 to 3 months using a restrictive compared to a liberal transfusion strategy, but the evidence is very uncertain (three studies; 431 participants; analysis unable to be completed due to heterogeneity; very low-certainty evidence). There may be little to no difference in the number of participants who suffer from any bleeding at 0 to 3 months using a restrictive compared to a liberal transfusion strategy (three studies; 448 participants; RR 0.91, 95% CI 0.78 to 1.06, P = 0.22; low-certainty evidence). There may be little to no difference in the number of participants who suffer from clinically significant bleeding at 0 to 3 months using a restrictive compared to a liberal transfusion strategy (four studies; 511 participants; RR: 0.94, 95% CI 0.74 to 1.19, P = 0.60; low-certainty evidence). There may be little to no difference in the number of participants who experience serious infections at 0 to 3 months using a restrictive compared to a liberal transfusion strategy (three studies, 451 participants; RR: 1.20, 95% CI 0.93 to 1.55, P = 0.17; low-certainty evidence). A restrictive transfusion strategy likely results in little to no difference in the length of hospital admission at 0 to 3 months compared to a liberal strategy (two studies; 388 participants; analysis unable to be completed due to heterogeneity in reporting; moderate-certainty evidence). There may be little to no difference between hospital readmission using a restrictive transfusion strategy compared to a liberal transfusion strategy (one study, 299 participants; RR: 0.89, 95% CI 0.52 to 1.50; P = 0.65; low-certainty evidence). Evidence from NRS The evidence is very uncertain whether a restrictive RBC transfusion strategy: reduces the risk of death within 100 days (one study, 84 participants, restrictive 1 death; liberal 1 death; very low-certainty evidence); or decreases the risk of clinically significant bleeding (one study, 84 participants, restrictive 3; liberal 8; very low-certainty evidence). No NRS reported on the other eligible outcomes.

Authors' conclusions: Findings from this review were based on seven studies and 644 participants. Definite conclusions are challenging given the relatively few included studies, low number of included participants, heterogeneity of intervention and outcome reporting, and overall certainty of evidence. To increase the certainty of the true effect of a restrictive RBC transfusion strategy on clinical outcomes, there is a need for rigorously designed and executed studies. The evidence is largely based on two populations: adults with acute leukaemia receiving intensive chemotherapy and adults with haematologic malignancy requiring HSCT. Despite the addition of 405 participants from three RCTs to the previous review's results, there is still insufficient evidence to answer this review's primary outcome. If we assume a mortality rate of 3% within 100 days, we would need a total of 1492 participants to have an 80% chance of detecting, at a 5% level of significance, an increase in all-cause mortality from 3% to 6%. Further RCTs are needed overall, particularly in children.

Trial registration: ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03086252 NCT00944112 NCT01328262 NCT01393496 NCT01491308 NCT01638416 NCT01648946 NCT02232568 NCT02535208 NCT02566577 NCT02648113 https://clinicaltrials.gov/ct2/show/NCT02835937 https://clinicaltrials.gov/ct2/show/NCT02899767 NCT03135457 NCT03296059 NCT03369210 https://clinicaltrials.gov/ct2/show/NCT03426553 https://clinicaltrials.gov/ct2/show/NCT03660228 https://clinicaltrials.gov/ct2/show/NCT03701217 NCT03871244 https://clinicaltrials.gov/ct2/show/NCT04226768 https://clinicaltrials.gov/ct2/show/NCT04454723 https://clinicaltrials.gov/ct2/show/NCT04506125 NCT04591574 NCT04757909 NCT04814264 NCT04879485 NCT04920045 https://clinicaltrials.gov/ct2/show/NCT03837171.

PubMed Disclaimer

Conflict of interest statement

Michael Radford: None to declare.

Lise Estcourt ‐ Coordinating editor of Cochrane Haematology (author was not involved in the editorial process of this review).

Susan Brunskill ‐ None to declare.

Megan Watson ‐ None to declare.

Donald Arnold ‐ None to declare.

Joanne Britto ‐ None to declare.

Emilie Sirotich ‐ Board membership: COVID‐19 Global Rheumatology Alliance, Canadian Arthritis Patient Alliance. Funding: CIHR, American College of Rheumatology, PDSA

Carolyn Doree ‐ None to declare.

Dean Ferguson ‐ Primary investigator of Tay 2020.

Tyler Pitre ‐ None to declare.

Figures

1
1
2
2
1.1
1.1. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 1: All‐cause mortality at 0 to 7 days
1.2
1.2. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 2: All‐cause mortality at 8 to 30 days
1.3
1.3. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 3: All‐cause mortality at 31 to 100 days
1.4
1.4. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 4: Death due to infection (0 to 3 months)
1.5
1.5. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 5: Death due to bleeding (0 to 3 months)
1.6
1.6. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 6: Chemotherapy‐related mortality (0 to 30 days)
1.7
1.7. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 7: Transplant‐related mortality (0 to 30 days)
1.8
1.8. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 8: Any bleeding ‐ WHO/CTCAE grade ≥ 1 or equivalent (0 to 3 months)
1.9
1.9. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 9: Clinically significant bleeding ‐ WHO/CTCAE grade ≥ 2 or equivalent (0 to 3 months)
1.10
1.10. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 10: Severe bleeding ‐ WHO/CTCAE grade ≥ 3 or equivalent (0 to 3 months)
1.11
1.11. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 11: Adverse transfusion reactions (0 to 3 months)
1.12
1.12. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 12: Serious infectious episodes (0 to 3 months)
1.13
1.13. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 13: Toxicity score for HSCT recipients ‐ Bearman Toxicity Score ≥ grade 3 or equivalent (0 to 3 months)
1.14
1.14. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 14: Number of participants with VOD (0 to 3 months)
1.15
1.15. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 15: Mean number of RBC transfusions (units) per participant (0 to 3 months)
1.16
1.16. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 16: Interval between RBC transfusions (days) (0 to 3 months)
1.17
1.17. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 17: Number of participants with PLT transfusions from study entry (0 to 3 months)
1.18
1.18. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 18: Number of PLT transfusion episodes per participant (0 to 3 months)
1.19
1.19. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 19: Number of PLT transfusions (doses) per participant (0 to 3 months)
1.20
1.20. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 20: Length of hospital admission (days) (0 to 3 months)
1.21
1.21. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 21: Length of intensive care admission (0 to 3 months)
1.22
1.22. Analysis
Comparison 1: Restrictive versus liberal red blood cell transfusion RCTs, Outcome 22: Hospital readmission (0 to 3 months)
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Byun 2023 (D) {published and unpublished data}
    1. Byun JM, Hong J, Shin D-Y, Koh Y, Yoon S-S, Kim I, et al. A prospective randomized study for optimal red blood cell use patients with acute myeloid leukemia receiving dose intensive chemotherapy. Blood 2022;140(Supplement 1):81-2. [DOI: ]
    1. Byun JM, Park W, Shin D-Y, Koh Y, Kim I, Yoon S-S, et al. A prospective randomized study for optimal use of red blood cell transfusion in patients with acute myeloid leukemia receiving intensive chemotherapy [Optimal RBC transfusion for hematologic malignancies]. Blood Transfusion 2023;21(6):479-87. - PMC - PubMed
Byun 2023 (S) {published data only}
    1. Byun JM, Park W, Shin D-Y, Koh Y, Kim I, Yoon S-S, et al. A prospective randomized study for optimal use of red blood cell transfusion in patients with acute myeloid leukemia receiving intensive chemotherapy. Blood Transfusion 2023;21(6):479-87. - PMC - PubMed
De Zern 2016 {published data only}
    1. De Zern AE, Williams K, King K, Hand W, Levis M, Smith BD, et al. Liberal vs. restrictive transfusion thresholds in leukemia patients: a feasibility pilot study. In: American Society of Hematology (ASH), the 57th Annual meeting & exposition, Orlando. (date accessed prior to 19 May 2024).
    1. De Zern AE, Williams K, Zahurak M, Hand W, Stephens RS, King KE, et al. Red blood cell transfusion triggers in acute leukemia: a randomized pilot study. Transfusion 2016;56(7):1750-7; erratum in: Transfusion 2016; 56(7) 1750-7. [DOI: 10.1111/trf.13658] - DOI - PMC - PubMed
    1. NCT02086773. Prospective randomized clinical feasibility study of red cell transfusion goals in patients with acute leukemias. clinicaltrials.gov/ct2/show/NCT02086773 (date received 4 March 2014).
Jansen 2004 {published data only}
    1. Jansen AJ, Caljouw MA, Hop WC, Van Rhenen DJ, Schipperus MR. Feasibility of a restrictive red-cell transfusion policy for patients treated with intensive chemotherapy for acute myeloid leukaemia. Transfusion Medicine 2004;14(1):33-8. - PubMed
Morton 2022 {published data only}
    1. ISRCTN96390716. Red cell transfusion in acute myeloid leukaemia (REAL). https://www.isrctn.com/ISRCTN96390716 (date received 23 Jan 2017).
    1. Morton S, Sekhar M, Smethurst H, Mora A, Hodge R, Hudson C, et al. Results for the REAL pilot randomised trial of red cell transfusion in acute myeloid leukaemia: is there sufficient evidence of equipoise to support a definitive study? British Journal of Haematology 2020;189:36-7.
Robitaille 2013 {published data only}
    1. NCT00937053. Maintaining a higher level of haemoglobin: effect on the white cells after bone marrow transplantation in children. clinicaltrials.gov/ct2/show/NCT00937053 (date received 9 August 2009).
    1. Robitaille N, Lacroix J, Alexandrov L, Clayton L, Cortier M, Schultz KR, et al. Excess of veno-occlusive disease in a randomized clinical trial on a higher trigger for red blood cell transfusion after bone marrow transplantation: a Canadian blood and marrow transplant group trial. Biology of Blood and Marrow Transplantation 2013;19(3):468-73. - PubMed
Tay 2020 {published data only}
    1. NCT01237639. Study of red blood cell transfusion triggers in patients undergoing hematopoietic stem cell transplantation (TRIST). clinicaltrials.gov/ct2/show/NCT01237639 (date received 13 October 2010).
    1. Tay J, Allan DS, Chatelain E, Coyle D, Elemary M, Fulford A, et al. Liberal versus restrictive red blood cell transfusion thresholds in hematopoietic cell transplantation: a randomized, open label, phase III, noninferiority trial [Liberal versus restrictive red blood cell transfusion thresholds in hematopoietic cell transplantation: a randomized, open label, phase III, noninferiority trial]. Journal of Clinical Oncology 2020;38(13):1463–73. [DOI: ] - PubMed
    1. Tay J, Tinmouth A, Fergusson D, Allan D. Transfusion of red cells in hematopoietic stem cell transplantation (TRIST): study protocol for a randomized controlled trial. Trials 2011;12:207. [DOI: 10.1186/1745-6215-12-207] - DOI - PMC - PubMed
Webert 2008 {published data only}
    1. Webert KE, Cook RJ, Couban S, Carruthers J, Lee KA, Blajchman MA, et al. A multicentre pilot-randomized controlled trial of the feasibility of an augmented red blood cell transfusion strategy for patients treated with induction chemotherapy for acute leukaemia or stem cell transplantation. Transfusion 2008;48(1):81-91. - PubMed

References to studies excluded from this review

Abels 1991 {published data only}
    1. Abels R, Gordon D, Nelson R, Krantz K, Ageeb M, Goon B, et al. Transfusion practice in advanced cancer patients. Blood 1991;78:474a.
ACTRN12620001097932 {published data only}ACTRN12620001097932
    1. ACTRN12620001097932. A mixed-methods pilot feasibility study of self-managing red cell transfusion requirements in chronic anaemia: quality of life for patients with long term anaemia self-managing red cell transfusions. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380490&... (date received 21 October 2020).
Al‐Darwish 2016 {published data only}
    1. Al-Darwish M, Farhan N, Al-Jebreen A, Allam R, Al-Ahmari A, Seraihy A, et al. The contribution of multiple packed red blood cell transfusions toward cardiac and liver dysfunction in pediatric patients with acute myeloid leukemia. Leukemia & Lymphoma 2016;57(10):2472-5. - PubMed
Almeida 2013 {published data only}
    1. Almeida JP, Galas F, Osawa E, Fukushima J, Moulin S, Park C, et al. Transfusion requirements in surgical oncology patients (TRISOP):a randomized, controlled trial. Critical Care 2013;17(Suppl 2):36410.1186/cc12302.
Bercovitz 2011 {published data only}
    1. Bercovitz RS, Dietz AC, Magid RN, Zantek ND, Smith AR, Quinones RR. What is the role of red blood cell transfusion threshold on number of transfusions in pediatric patients after hematopoietic stem cell transplant? Blood 2011;118(21):1263.
Bergamin 2017 {published data only}
    1. Bergamin FS, Almeida JP, Landoni G, Galas FRBG, Fukushima JT, Fominskiy E, et al. Liberal versus restrictive transfusion strategy in critically III oncologic patients: the transfusion requirements in critically III oncologic patients randomized controlled trial. Critical Care Medicine 2017;45(5):766-73. - PubMed
Berger 2012 {published data only}
    1. Berger MD, Gerber B, Arn K, Senn O, Schanz U, Stussi G. Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation. Haematologica 2012;97(1):116-22. - PMC - PubMed
Bruun 2011 {published data only}
    1. Bruun KH, Norgaard A, Johansson P, Daugaard G, Sorensen M. HaemOPtimal: randomized feasibility study of the optimal haemoglobin trigger for red blood cell transfusion (RBC) of anaemic cancer patients (PTS) treated with chemotherapy (CT). Transfusion Alternatives in Transfusion Medicine 2011;12(1):19-20.
Cahill 2017 {published data only}
    1. Cahill C, Blumberg N, Schmidt AE, Kirkley S, Refaai MA. Patient blood management: an initiative aimed at improving outcomes while decreasing red cell transfusions with specialty guidelines for hematology patients. Blood. Conference: 59th Annual Meeting of the American Society of Hematology, ASH 2017;130(Suppl 1):3738.
Cannas 2015 {published data only}
    1. Cannas G, Fattoum J, Raba M, Dolange H, Barday G, François M, et al. Transfusion dependency at diagnosis and transfusion intensity during initial chemotherapy are associated with poorer outcomes in adult acute myeloid leukaemia. Annals of Hematology 2015;94:1797–1806. [DOI: DOI 10.1007/s00277-015-2456-2] - PubMed
Carson 2014 {published data only}
    1. Carson JL, Strair R. Transfusion strategies in hematologic and nonhematologic disease. Hematology, the American Society of Hematology Education Program (date accessed prior to 19 May 2024);5(1):548-52. - PubMed
Chantepie 2015 {published data only}
    1. Chantepie SP, Mear JB, Guittet L, Dervaux B, Marolleau JP, Jardin F, et al. Transfusion strategy in hematological intensive care unit: study protocol for a randomized controlled trial. Trials 2015;16:533. [DOI: 10.1186/s13063-015-1057-7] - DOI - PMC - PubMed
    1. Chantepie SP, Mear JB, Parienti JJ, Bazin A, Benabed K, Cheze S, et al. Blood transfusion in hematologic intensive care unit. Transfusion 2017;57(2):296-302. - PubMed
    1. NCT02461264. Randomized trial of two transfusion strategies in patients hospitalized for acute leukemia induction chemotherapy or hematopoietic stem cells with medico-economic evaluation (1 VERSUS 2 CGR). https://clinicaltrials.gov/ct2/show/study/NCT02461264 (date received 28 May 2015).
ChiCTR2000031902 {published data only}ChiCTR2000031902
    1. ChiCTR2000032902. Study on the mechanism and safety evaluation of hyperhemopoiesis in human. https://www.chictr.org.cn/showprojen.aspx?proj=16483 (date received 14 April 2020).
ChiCTR2100053648 {published data only}
    1. ChiCTR2100053648. Mechanism of decision-making in stages for perioperative restricted transfusion of red blood cells based on oxygen saturation in brain regions. https://www.chictr.org.cn/showproj.html?proj=139465 (date received 26 November 2021).
CTRI/2017/01/007726 {published data only}CTRI/2017/01/007726
    1. CTRI/2017/01/007726. A clinical trial to compare lower(hemoglobin threshold for PRBC transfusion 7 gm/dl) vs higher hemoglobin threshold (hemoglobin threshold for PRBC transfusion 9 gm/dl) for transfusion in children with acute respiratory distress syndrome. http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=14266 (date received 19 January 2017).
Halkes 2019 {published data only}
    1. Halkes C, De Wreede LC, Knol C, Simand C, Aljurf M, Tbakhi A, et al, European Society for Blood, Marrow Transplantation Severe Aplastic Anemia Working Party. Allogeneic stem cell transplantation for acquired pure red cell aplasia. American Journal of Hematology 2019;94(11):E294-6. - PubMed
Holst 2013 {published data only}
    1. Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J. Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 2015;350:h1354. - PMC - PubMed
ISRCTN08118744 {published data only}ISRCTN08118744
    1. Informing fresh versus standard Issue red cell management. https://www.isrctn.com/ISRCTN08118744 (date received 23 November 2011). [DOI: ]
ISRCTN26088319 {published data only}
    1. ISRCTN26088319. A trial looking at blood transfusions and quality of life in people with myelodysplastic syndrome (REDDS). controlled-trials.com/ISRCTN26088319 (date received 13 November 2014).
ISRCTN37246456 {published data only}ISRCTN37246456
    1. ISRCTN37246456. Transfusion requirements in paediatric intensive care unit: a multicentre randomised controlled non-inferiority clinical trial. https://www.isrctn.com/ISRCTN37246456 (date received 27 June 2004).
Jansen 2020 {published data only}
    1. Jansen AJG, Van den Bosch J, Te Boekhorst PAW, Schipperus MR, Beckers EAM. Results of the prematurely terminated TEMPLE randomized controlled trial in patients with myelodysplastic syndrome: liberal versus restrictive red blood cell transfusion threshold. Transfusion 2020;60(4):879-81. - PubMed
Jekarl 2023 {published data only}
    1. Jekarl DW, Kim JK, Han JH, Lee H, Yoo J, Lim J, et al. Transfusion support in hematopoietic stem cell transplantation. Blood Research 30 April 2023;58((Suppl 1)):S1–S7. [DOI: ] - PMC - PubMed
Jones 2020 {published data only}
    1. Jones K, Armstrong S, Sanford K. Blood utilization of hematology oncology patients during COVID-19 crisis using temporary transfusion restrictions. Transfusion 2020;60((SUPPL 5)):283A-284A. [DOI: ]
Lightdale 2012 {published data only}
    1. Lightdale JR, Randolph AG, Tran CM, Jiang H, Colon A, Houlahan K, et al. Impact of a conservative red blood cell transfusion strategy in children undergoing hematopoietic stem cell transplantation. Biology of Blood and Marrow Transplantation 2012;18(5):813-7. - PubMed
Mear 2014 {published data only}
    1. Mear JB, Chantepie S, Gac AC, Bazin A, Reman O. A restrictive strategy reduces the number of transfused packed red blood cells in allograft recipients. Blood 2014;124(21):5016.
NCT00202371 {published data only}
    1. NCT00202371. Transfusion effects in myelodysplastic patients: limiting exposure. clinicaltrials.gov/ct2/show/NCT00202371 (date received 12 September 2005).
NCT00944112 {published data only}
    1. A feasibility randomized trial comparing restrictive and liberal blood transfusion strategies in patients requiring four or more days in intensive care (RELIEVE). https://clinicaltrials.gov/ct2/show/NCT00944112 (date received 21 July 2009).
NCT01328262 {published data only}
    1. NCT01328262. A randomized clinical trial on hemoglobin dose and patient matching. https://clinicaltrials.gov/ct2/show/NCT01328262 (date received 24 February 2011).
NCT01393496 {published data only}
    1. NCT01393496. Effects of transfusion thresholds on neurocognitive outcome of extremely low birth weight Infants (ETTNO)- a Blinded Randomized Controlled Multicenter Trial. https://clinicaltrials.gov/ct2/show/NCT01393496 (date received 12 July 2011).
NCT01491308 {published data only}
    1. NCT01491308. Restrictive versus liberal red cell transfusion strategy in orthopedic-oncology patients undergoing surgery - a randomized controlled study. https://clinicaltrials.gov/ct2/show/NCT01491308 (date received 08 December 2011).
NCT01638416 {published data only}
    1. NCT01638416. A multi-centre randomised double blinded phase III trial of the effect of standard issue red blood cell blood units on mortality compared to freshest available red blood cell units. https://clinicaltrials.gov/ct2/show/NCT01638416 (date received 9 July 2012).
NCT01648946 {published data only}
    1. NCT01648946. Transfusion requirements in critical clinical oncologic patients: a phase 3 randomized controlled clinical trial (TRICCOP STUDY). https://clinicaltrials.gov/ct2/show/NCT01648946 (date received 19 July 2012).
NCT02099669 {published data only}
    1. NCT02099669. Red blood cell transfusion thresholds and QOL in MDS (EnhanceRBC). clinicaltrials.gov/ct2/show/NCT02099669 (date received 26 March 2014).
NCT02232568 {published data only}
    1. NCT02232568. Trial of feedback on blood use (TOFU). https://clinicaltrials.gov/ct2/show/NCT02232568 (date received 3 September 2014).
NCT02535208 {published data only}
    1. NCT02535208. A pilot randomized trial of restrictive red blood cell transfusion guidelines used in combination with near-infrared spectroscopy splanchnic-cerebral oxygenation ratio evaluations versus liberal red blood cell transfusion guidelines in preterm infants. https://clinicaltrials.gov/ct2/show/NCT02535208 (date received August 18, 2015).
NCT02566577 {published data only}
    1. NCT02566577. Physiologic effects of RBC transfusion. https://clinicaltrials.gov/ct2/show/NCT02566577 (date received 1 October 2015).
NCT02648113 {published data only}
    1. NCT02648113. Cost-effectiveness and cost-utility of liberal vs restrictive red blood cell transfusion strategies in patients with acute myocardial infarction and anaemia (REALITY). https://clinicaltrials.gov/ct2/show/NCT02648113 (date received 5 January 2016).
NCT02835937 {published data only}
    1. NCT02835937. Red blood cell transfusion in the ambulatory setting: impact on home functional status. https://clinicaltrials.gov/ct2/show/NCT02835937 (date received 14 July 2016).
NCT02899767 {published data only}
    1. NCT02899767. Transfusion in adult acute myeloid leukemia. https://clinicaltrials.gov/ct2/show/NCT02899767 (date received 25 August 2016).
NCT03086252 {published data only}
    1. NCT03086252. Patient-driven transfusion thresholds in hematological disorders: a pilot study. https://clinicaltrials.gov/ct2/show/NCT03086252 (date received 17 March 2017).
NCT03135457 {published data only}
    1. NCT03135457. A cross-over randomized controlled trial; pulmonary edema detection after fluid loading with blood versus saline in patients after CABG. https://clinicaltrials.gov/ct2/show/NCT03135457 (date received 26 April 2017).
NCT03296059 {published data only}
    1. NCT03296059. Transfusion of red bood cells for acute respiratory distress syndrome(ARDS) in neonates. https://clinicaltrials.gov/ct2/show/NCT03296059 (date received 25 September 2017).
NCT03369210 {published data only}
    1. NCT03369210. Liberal transfusion strategy in elderly patients (LIBERAL). https://clinicaltrials.gov/ct2/show/NCT03369210 (date received 27 November 2017).
NCT03426553 {published data only}
    1. NCT03426553. Clinical use of pathogen reduced red blood cell suspension. https://clinicaltrials.gov/ct2/show/NCT03426553 (date received 10 October 2017).
NCT03660228 {published data only}
    1. NCT03660228. Peri-transfusion QOL assessments (PTQA): a new paradigm of transfusion decision support for patients with MDS. https://clinicaltrials.gov/ct2/show/NCT03660228 (date received 4 September 2018).
NCT03701217 {published data only}
    1. NCT03701217. Eltrombopag used in thrombocytopenia after consolidation therapy in AML. https://clinicaltrials.gov/ct2/show/NCT03701217 (date received 7 October 2018).
NCT03871244 {published data only}
    1. NCT03871244. Pilot optimizing transfusion thresholds in critically-ill children with anaemia (P-OpTTICCA). https://clinicaltrials.gov/ct2/show/NCT03871244 (date received 6 March 2019).
NCT04226768 {published data only}
    1. NCT04226768. Enhanced palliative care in MDS and AML. https://clinicaltrials.gov/ct2/show/NCT04226768 (date received 6 January 2020).
NCT04454723 {published data only}
    1. NCT04454723. Impact of palliative transfusions on quality of life in patients with blood cancers on hospice. https://clinicaltrials.gov/ct2/show/NCT04454723 (date received 12 June 2020).
NCT04506125 {published data only}
    1. NCT04506125. Liberal versus restrictive transfusion threshold in oncologic surgery (LIBERTY1). https://clinicaltrials.gov/ct2/show/NCT04506125 (date received 29 July 2020).
NCT04591574 {published data only}
    1. NCT04591574. ABC - a post intensive care anaemia management trial. https://clinicaltrials.gov/ct2/show/NCT04591574 (date received 3 September 2020).
NCT04757909 {published data only}
    1. NCT04757909. Detection of anemizations in primary care (ANHEMOG) [Early detection of anemizations in primary care using hemoglobinometer: randomized clinical trial protocol]. https://clinicaltrials.gov/ct2/show/NCT04757909 (date received 15 February 2021).
NCT04814264 {published data only}
    1. NCT04814264. Pilot study of sex-matched vs. sex-mismatched red blood cell transfusion [Pilot study of sex-matched vs. sex-mismatched red blood cell transfusion]. https://clinicaltrials.gov/ct2/show/NCT04814264 (date received 16 March 2021).
NCT04879485 {published data only}
    1. NCT04879485. Prehospital transfusion strategy in bleeding patients. https://clinicaltrials.gov/ct2/show/NCT04879485 (date received 29 April 2021).
NCT04920045 {published data only}
    1. NCT04920045. A trial to assess the effect of transfusion strategies on fatigability levels after hospital discharge [A trial comparing a liberal versus restrictive red blood cell transfusion strategy on fatigability, fatigue, and activity levels after discharge in hospitalized patients with anemia]. https://www.clinicaltrials.gov/ct2/show/NCT04920045 (date received 24 May 2021).
NCT05399732 {published data only}
    1. NCT05399732. Efficacy and safety in transfusion independent non-severe aplastic anemia. https://clinicaltrials.gov/ct2/show/NCT05399732 (date received 24 Mary 2022).
NL9289 {published data only}NL9289
    1. NL9289. REMOTE 2 [Comparison of different transfusion strategies for red blood cell transfusion dependent MDS patients – a cross-over study with remote patient monitoring]. https://www.trialregister.nl/trial/9289 (date received 10 February 2021).
NTR2684 {published data only}
    1. NTR2684. Transfusion as supportive care for the improvement of the quality of life. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2684 (date received 5 January 2011).
NTR334 {published data only}NTR334
    1. NTR334. TEMPLE Study [Transfusion effects of myelodysplastic patients: limiting exposure]. https://www.trialregister.nl/trial/334 (date received 10 September 2005).
Paananen 2009 {published data only}
    1. Paananen P, Arola MO, Pelliniemi T, Salmi TT, Lahteenmaki PM. Evaluation of the effects of different transfusion trigger levels during the treatment of childhood acute lymphoblastic leukemia. Journal of Pediatric Hematology/Oncology 2009;31:745-9. - PubMed
Patil 2013 {published data only}
    1. Patil NR, Marques M, Mineishi S, Rudolph S, Vaughan W, Innis-Shelton R, et al. A restrictive red cell transfusion approach does not adversely affect day 100 or 1 year survival in multiple myeloma patients undergoing autologous peripheral blood stem cell transplantation. Biology of Blood and Marrow Transplantation 2013;19:S268.
Pervaiz 2023 {published data only}
    1. Pervaiz O, Dhanapal J, Pillai L, Pavord S, Leary H, Eyre T. Real world reduction in red cell transfusion with restrictive transfusion threshold in haematology inpatients. Transfusion Medicine 2023;06(32):1-3. [DOI: ] - PubMed
Prescott 2016 {published data only}
    1. Prescott L, Taylor J, Lopez-Olivo M, Munsell M, VonVille H, Lairso D, et al. How low should we go: a systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology. Cancer Treatment Reviews 2016;46:1-8. - PMC - PubMed
Rose 2017 {published data only}
    1. Rose C. [Transfusions in myelodysplastic syndromes]. Transfusion Clinique et Biologique 2017;24(3):209-15. - PubMed
Roubinian 2016 {published data only}
    1. Roubinian N, Carson JL. Red blood cell transfusion strategies in adult and pediatric patients with malignancy. Hematology/Oncology Clinics of North America 2016;30:529-40. - PubMed
Rydén 2019 {published data only}
    1. Ryden J, Edgren G, Karimi M, Walldin G, Tobiasson M, Wikman A, et al. Male sex and the pattern of recurrent myeloid mutations are strong independent predictors of blood transfusion intensity in patients with myelodysplastic syndromes. Leukemia 2019;33(2):522-7. - PubMed
Seifried 2017 {published data only}
    1. Seifried E, Mueller M. Blood transfusion: one unit too much or one unit too few - which poses the least risk to the patient? Vox Sanguinis 2017;112 (Supplement 1):20.
Solves Alcaina 2020 {published data only}
    1. Solves Alcaina P, Garcia R, Orti C, Navarro I, Gomez I, Plume G, et al. Single-unit versus double-unit RBC transfusion policy in patients undergoing hematopoietic stem cell transplantation: preliminary results. Vox Sanguinis 2020;115(S1):5-396. [DOI: ]
Stanworth 2018 {published data only}
    1. Stanworth S, Killick S, McQuilten Z, Karakantza M, Smethurst H, Pankhurst L, et al. A feasibility randomized trial of red cell transfusion thresholds in myelodysplasia. Blood 2018;132((Supplement 1)):527.
Stanworth 2020 {published data only}
    1. Stanworth SJ, Killick S, McQuilten ZK, Karakantza M, Weinkove R, Smethurst H, et al, Redds Investigators. Red cell transfusion in outpatients with myelodysplastic syndromes: a feasibility and exploratory randomised trial. British Journal of Haematology 2020;189(2):279-90. - PubMed
Touzon 2017 {published data only}
    1. Touzon Andion MI, Gestal M, Varela A, Castro M, Moinelo C, Garcia De Villaescusa R. Liberal vs restrictive comparative transfusional study in oncological population. Haematologica 2017;102 (Supplement 2):880-1.
Yakymenko 2015 {published data only}
    1. NCT01116479. Optimal transfusion in anaemic cancer patients treated with chemotherapy (HaemOPtimal). https://clinicaltrials.gov/ct2/show/NCT01116479 (date received 28 April 2010).
    1. Yakymenko D, Frandsen KB, Christensen IJ, Norgaard A, Johansson P, Daugaard G, et al. Haemoptimal: randomized feasibility study of the optimal hemoglobin trigger for red blood cell transfusion to anemic cancer patients treated with chemotherapy. Supportive Care in Cancer 2015;23(Supp 1):S275. - PubMed
Yakymenko 2018 {published data only}
    1. Yakymenko D, Frandsen KB, Christensen IJ, Norgaard A, Johansson PI, Daugaard G, et al. Randomised feasibility study of a more liberal haemoglobin trigger for red blood cell transfusion compared to standard practice in anaemic cancer patients treated with chemotherapy. Transfusion Medicine 2018;28(3):208-15. - PubMed
Zhao 2018 {published data only}
    1. Zhao H, Zhou H, Cao Q, Wang C, Bai J, Lv P, et al. Effect of allogeneic blood transfusion on levels of IL-6 and sIL-R2 in peripheral blood of children with acute lymphocytic leukemia. Oncology Letters 2018;16((1)):849-52. [DOI: ] - PMC - PubMed

References to ongoing studies

ISRCTN17438123 {unpublished data only}
    1. ISRCTN17438123. A small pilot feasibility study for a possible randomised control trial comparing clinical outcomes and quality of life following two different transfusion strategies in children undergoing allogeneic hematopoietic stem cell transplant. https://www.isrctn.com/ISRCTN17438123 20/05/2019.
NCT03837171 {published data only}
    1. NCT03837171. TRANSfusion in Patients with Onco-hematological malignancies ResusciTated from septic shock (TRANSPORT). https://clinicaltrials.gov/ct2/show/NCT03837171 2019-02-08.

Additional references

Adam 1942
    1. Adam RC, Lundy JS. Anesthesia in cases of poor risk. Some suggestions for decreasing the risk. Surgery, Gynecology & Obstetrics 1942;74:1011-101.
Almeida 2015
    1. De Almeida JP, Vincent JL, Galas FR, De Almeida EP, Fukushima JT, Osawa EA, et al. Transfusion requirements in surgical oncology patientscancer patients: a prospective, randomized controlled trial. Anesthesiology 2015;122:29-38. - PubMed
Bearman 1988
    1. Bearman SI, Appelbaum FR, Buckner CD, Petersen FB, Fisher LD, Clift RA, et al. Regimen-related toxicity in patients undergoing bone marrow transplantation. Journal of Clinical Oncology 1988;6(10):1562-8. - PubMed
Bergamin 2017
    1. Bergamin FS, Almeida JP, Landoni G, Galas FRBG, Fukushima JT, Fominskiy E, et al. Liberal versus restrictive transfusion strategy in critically Ill oncologic patients: the transfusion requirements in critically Ill oncologic patients randomized controlled trial. Critical Care Medicine 2017;45:766-73. - PubMed
Borkent‐Raven 2010
    1. Borkent-Raven BA, Janssen MP, Van Der Poel CL, Schaasberg WP, Bonsel GJ, Van Hout BA. The PROTON study: profiles of blood product transfusion recipients in the Netherlands. Vox Sanguinis 2010;99(1):54-64. - PubMed
Buccheri 1996
    1. Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. European Journal of Cancer 1996;32A(7):1135-41. - PubMed
Buckstein 2020
    1. Buckstein RJ, Prica A, Leber B, Heddle N, Yee KWL, Stanworth SJ, et al. RBC-Enhance: a randomized pilot feasibility trial of red cell transfusion thresholds in myelodysplastic syndromes. Blood 2020;136(Supplement 1):3–4. [DOI: ]
Carson 2012
    1. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Annals of Internal Medicine 2012;157(1):49-58. - PubMed
Carson 2013
    1. Carson JL, Brooks MM, Abbott JD, Chaitman B, Kelsey SF, Triulzi DJ, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. American Heart Journal 2013;165(6):964-71. - PMC - PubMed
Carson 2016
    1. Carson JL, Stanworth SJ, Roubinian N, Fergusson DA, Triulzi D, Doree C, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No: CD002042. [DOI: 10.1002/14651858.CD002042.pub4] - DOI - PMC - PubMed
Carson 2021
    1. Carson JL, Stanworth SJ, Dennis JA, Trivella M, Roubinian N, Fergusson DA, et al. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database of Systematic Reviews 2021, Issue 12. Art. No: CD002042. [DOI: 10.1002/14651858.CD002042.pub5] - DOI - PMC - PubMed
Cella 1997
    1. Cella D. The functional assessment of cancer therapy-anemia (FACT-An) scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Seminars in Hematology 1997;34:13-9. - PubMed
Chantepie 2021
    1. Chantepie S, Mear J-B, Briant AR, Vilque J-P, Gac A-C, Cheze S, et al. Single-unit transfusion is non inferior to double unit transfusion in patients with hematological disorders receiving allogeneic or autologous bone marrow transplant or induction chemotherapy for acute leukemia: the 1 versus 2 prospective multicentric randomized clinical trial. Blood 2021;138(Supplement 1):2141.
Chong 2018
    1. Chong MA, Krishnan R, Cheng D, Martin J. Should transfusion trigger thresholds differ for critical care versus perioperative patients? A meta-analysis of randomized trials. Critical Care Medicine 2018;46(2):252-63. [DOI: 10.1097/CCM.0000000000002873] - DOI - PMC - PubMed
Cook 1997
    1. Cook RJ, Lawless JF. Marginal analysis of recurrent events and a terminating event. Statistics in Medicine 1997;16(8):911-24. - PubMed
CTCAE 2017
    1. National Institutes of Health, National Cancer Institute. Common terminology criteria for adverse events (CTCAE) version 5.0. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs... (accessed 13 July 2021):3-146.
Dalle 2016
    1. Dalle J-H, Giralt SA. Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: risk factors and stratification, prophylaxis, and treatment. Biology of Blood and Marrow Transplantation 2016;22(3):400-9. - PubMed
Deeks 2021
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook.
Devlin 2018
    1. Devlin N, Shah K, Feng Y, Mulhern B, Van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Economics 2018;27(1):7-22. - PMC - PubMed
Eugster 2005
    1. Eugster M, Reinhart WH. The influence of the haematocrit on primary haemostasis in vitro. Thrombosis and Haemostosis 2005;94(6):1213-8. - PubMed
EuroQol 1990
    1. EuroQol Group. EuroQol: A new facility for the measurement of health-related quality of life. Health Policy 16 1990;16(3):199-208. - PubMed
Fergusson 2004
    1. Fergusson D, Khanna MP, Tinmouth A, Hébert PC. Transfusion of leukoreduced red blood cells may decrease postoperative infections: two meta-analyses of randomized controlled trials. Canadian Journal of Anaesthesia 2004 ;51(5):417-24. [DOI: doi: 10.1007/BF03018302] [PMID: PMID: 15128625] - PubMed
Glanville 2019
    1. Glanville J, Dooley G, Wisniewski S, Foxlee R, Noel-Storr A. Development of a search filter to identify reports of controlled clinical trials within CINAHL Plus. Health Information and Libraries Journal 2019;36(1):73-90. [DOI: ] - PubMed
Higgins 2021
    1. Higgins JPT, Li T, Sterne J, RoB 2 Working Group on cross-over trials. Revised Cochrane risk of bias tool for randomized trials (RoB 2). Additional considerations for crossover trials. https://www.riskofbias.info/welcome/rob-2-0-tool/rob-2-for-crossover-trials 2021:1-16.
Higgins 2022a
    1. Higgins JPT, Li T, Deeks JJ (editors). Chapter 6: Choosing effect measures and computing estimates of effect. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022.. Available from www.training.cochrane.org/handbook.
Higgins 2022b
    1. Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022.. Available from www.training.cochrane.org/handbook..
Higgins 2022c
    1. Higgins JPT, Eldridge S, Li T (editors). Chapter 23: Including variants on randomized trials. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022.. Available from www.training.cochrane.org/handbook.
Ho 1998
    1. Ho CH. The hemostatic effect of packed red cell transfusion in patients with anemia. Transfusion 1998;38:1011-4. - PubMed
Holst 2015
    1. Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J. Restrictive versus liberal transfusion strategy for guiding red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 2015;350:h1354. - PMC - PubMed
Hébert 1999
    1. Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagiarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group.. New England Journal of Medicine 1999;340(6):409-17. - PubMed
Jansen 2020
    1. Jansen AJG, Van den Bosch J, Te Boekhorst PAW, Schipperus MR, Beckers EAM. Results of the prematurely terminated TEMPLE randomized controlled trial in patients with myelodysplastic syndrome: liberal versus restrictive red blood cell transfusion threshold. Transfusion 2020;60(4):879-81. [DOI: doi: 10.1111/trf.15708] - PubMed
Klein 2007
    1. Klein HG, Spahn DR, Carson JL. Red blood cell transfusion in clinical practice. Lancet 2007;370(9585):415-26. - PubMed
Knight 2004
    1. Knight K, Wade S, Balducci L. Prevalence and outcomes of anaemia in cancer: a systematic review of the literature. American Journal of Medicine 2004;116(7 Suppl 1):11-26. - PubMed
Lee 2014
    1. Lee JM, Chun HJ, Lee JS. Target level hemoglobin correction in patients with acute non-variceal upper gastrointestinal bleeding. Gastroenterology 2014;146(5 suppl. 1):S-321.
Lefebvre 2023
    1. Lefebvre C, Glanville J, Briscoe S, Featherstone R, Littlewood A, Marshall C, et al. Chapter 4: Searching for and selecting studies. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022.. Available from www.training.cochrane.org/handbook.
Littlewood 2002
    1. Littlewood T, Mandelli F. The effects of anemia in hematologic malignancies: more than a symptom. Seminars in Oncology 2002;29(3 Suppl 8):40-4. - PubMed
Luo 2018
    1. Luo B-R, Guo T-H, Yang D-M, Cheng F, Huang Y-S. Restrictive vs. liberal transfusion for cancer patients: a meta-analysis of randomized controlled trials. International Journal of Clinical and Experimental Medicine 2018;11(9):8845-54. [ISSN: ISSN:1940-5901/IJCEM0064978]
McGuinness 2020
    1. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Research Synthesis Methods 2020;n/a(n/a):55-61. [DOI: 10.1002/jrsm.1411] - DOI - PubMed
McQuellon 1997
    1. McQuellon RP, Russell GB, Cella DF, Craven BL, Brady M, Bonomi A, et al. Quality of life measurement in bone marrow transplantation: development of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) scale. Bone Marrow Transplant 1997;19:357-68. - PubMed
Mendoza 1999
    1. Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 1999;85:1186-96. - PubMed
Narayan 2019
    1. Narayan S, Poles D, Bellamy M, Spinks C, Mistry H, Carter-Graham S, et al, Serious Hazards of Transfusion (SHOT) Steering Group. The 2018 Annual SHOT Report. https://www.shotuk.org/wp-content/uploads/myimages/SHOT-Report-2018_Web_... (accessed 31 May 2020).
Nivo 2001
    1. Nevo S, Vogelsang GB. Acute bleeding complications in patients after bone marrow transplantation. Current Opinion in Hematology 2001;8(5):319-25. [DOI: ] - PubMed
Odutayo 2017
    1. Odutayo A, Desborough MJ, Trivella M, Stanley AJ, Dorée C, Collins GS, et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterology & Hepatology 2017;2(5):354-60. - PubMed
Page 2021
    1. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann T, Mulrow C, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews 2021;10(89):1-9. - PMC - PubMed
Palmieri 2017
    1. Palmieri T. Children are not little adults: blood transfusion in children with burn injury. Burns and Trauma 2017;5(24):1-6. [DOI: 10.1186/s41038-017-0090-z] - DOI - PMC - PubMed
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815-34. - PubMed
Pawson 2002
    1. Pawson R, Grant-Casey J, Kift C, Murphy MF. Red cell transfusion triggers in patients with haematological malignancy: a national audit. Clinical Transfusion Practice and Apheresis. Transfusion Medicine 2002;12:38-46.
Quintó 2006
    1. Quintó L, Aponte JJ, Menéndez C, Sacarlal J, Aide P, Espasa M, et al. Relationship between haemoglobin and haematocrit in the definition of anaemia. Tropical Medicine and International Health 2006;11(8):1295-302. - PubMed
Reeves 2021
    1. Reeves BC, Deeks JJ, Higgins JPT, Shea B, Tugwell P, Wells GA. Chapter 24: Including non-randomized studies on intervention effects. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021.. Available from www.training.cochrane.org/handbook.
RevMan Web 2021 [Computer program]
    1. Review Manager Web (RevMan Web). Version 3.3.0. The Cochrane Collaboration, 2021. Available at revman.cochrane.org.
Robertson 2014
    1. Robertson CS, Hannay HJ, Yamal JM, Gopinath S, Goodman JC, Tilley BC, Epo Severe TBI Trial Investigators. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 2014;312(1):36-47. [DOI: doi: 10.1001/jama.2014.6490] [PMID: PMID: 25058216; PMCID: PMC4113910] - PMC - PubMed
Rohde 2014
    1. Rohde J, Dimcheff D, Blumberg N, Saint S, Langa K, Kuhn L, et al. Health care–associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA 2014;311(13):1317–26. - PMC - PubMed
Salpeter 2014
    1. Salpeter SR, Buckley JS, Chatterjee S. Impact of more restrictive blood transfusion strategies on clinical outcomes: a meta-analysis and systematic review. American Journal of Medicine 2014;127:124-31. - PubMed
Schünemann 2022a
    1. Schünemann HJ, Higgins JPT, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Schünemann 2022b
    1. Schünemann HJ, Vist GE, Higgins JPT, Santesso N, Deeks JJ, Glasziou P, et al. Chapter 15: Interpreting results and drawing conclusions. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook.
Stanworth 2013
    1. Stanworth SJ, Estcourt LJ, Powter G, Kahan B, Dyer C, Choo L, et al, TOPPS Investigators. A no-prophylaxis platelet-transfusion strategy for hematologic cancers. New England Journal of Medicine 2013;368:1771-80. - PubMed
Stanworth 2020
    1. Stanworth SJ, Killick S, McQuilten ZK, Karakantza M, Weinkove R, Smethurst H, et al. Red cell transfusion in outpatients with myelodysplastic syndromes: a feasibility and exploratory randomised trial. British Journal of Haematology 2020;189:279-90. - PubMed
Sterne 2016
    1. Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions. BMJ 2016;355(4919):1-7. - PMC - PubMed
Sterne 2019
    1. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366(14898):1-8. - PubMed
Tay 2011
    1. Tay J, Tinmouth A, Fergusson D, Allan D. Transfusion of red cells in hematopoietic stem cell transplantation (TRIST): study protocol for a randomized controlled trial. Trials 2011;12(207):1-8. - PMC - PubMed
Thakar 2021
    1. Thakar S, Gabarin N, Gupta A, Radford M, Warkentin TE, Arnold DM. Anemia-induced bleeding in patients with platelet disorders. Transfusion Medicine Review 2021;35(3):22-8. [DOI: 10.1016/j.tmrv.2021.06.001] - DOI - PubMed
Tierney 2007
    1. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 2007;8:16. - PMC - PubMed
Tinegate 2016
    1. Tinegate H, Pendry K, Murphy M, Babra P, Grant-Casey J, Hopkinson C, et al. Where do all the red blood cells (RBCs) go? Results of a survey of RBC use in England and North Wales in 2014. Transfusion 2016;56:139-45. [DOI: ] - PubMed
Trentino 2020
    1. Trentino KM, Farmer SL, Leahy MF, Sanfilippo FM, Isbister JP, Mayberry R, et al. Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: an overview of systematic reviews. BMC Medicine 2020;18(154):1-14. - PMC - PubMed
Uhl 2017
    1. Uhl L, Assmann S, Hamza T, Harrison R, Gernsheimer T, Slichter S. Laboratory predictors of bleeding and the effect of platelet and RBC transfusions on bleeding outcomes in the PLADO trial. Blood 2017;130(10):1247-58. - PMC - PubMed
Valeri 2001
    1. Valeri CR, Cassidy G, Pivacek LE, Ragno G, Lieberthal W, Crowley JP, et al. Anemia-induced increase in the bleeding time: implications for treatment of nonsurgical blood loss. Transfusion 2001;41(8):977-83. - PubMed
Villarejo 1999
    1. Villarejo F, Rizzolo M, Lopez E, Domeniconi G, Arto G, Apezteguia C. Acute anemia in upper gastrointestinal bleeding. Safety margins for handling without red blood cell transfusions [Anemia aguda en la hemorragia digestiva alta. Márgenes de seguridad para su manejo sin transfusiones de glóbulos rojos]. Acta Gastroenterologica Latinoamericana 1999;29:261-70. - PubMed
Vossoughi 2019
    1. Vossoughi S, Gorlin J, Kessler DA, Hillyer CD, Van Buren NL, Jimenez A, et al. Ten years of TRALI mitigation: measuring our progress. Transfusion 2019;59(8):2567-74. [DOI: ] - PubMed
Webert 2006
    1. Webert KE, Cook RJ, Sigouin CS, Rebulla P, Heddle NM. The risk of bleeding in thrombocytopenic patients with acute myeloid leukemia. Haematologica 2006;91:1530-7. - PubMed
Whitaker 2015
    1. Whitaker BI, Rajbhandary S, Harris A. The 2013 AABB blood collection, utilization, and patient blood management survey report. http://www.aabb.org/research/hemovigilance/bloodsurvey/Pages/default.aspx (accessed 31 May 2020). - PubMed
Xenocostas 2003
    1. Xenocostas A, Yee A, Wong CJ, Sutton DMC, Lipton JH, Kiss TL, et al. RBC transfusion requirements after allogeneic marrow transplantation: impact of the before-transplant Hb level on transfusion and early survival. Transfusion 2003;43(3):373-82. - PubMed
Yakymenko 2018
    1. Yakymenko D, Frandsen KB, Christensen IJ, Norgaard A, Johansson PI, Daugaard G, et al. Randomised feasibility study of a more liberal haemoglobin trigger for red blood cell transfusion compared to standard practice in anaemic cancer patients treated with chemotherapy. Transfusion Medicine 2018;28(3):208-15. - PubMed

References to other published versions of this review

Butler 2014
    1. Butler C, Tay J, Doree C, Brunskill SJ, Trivella M, Fergusson DA, et al. Restrictive versus liberal red blood cell transfusion strategies for patients with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No: CD011305. [DOI: 10.1002/14651858.CD011305] - DOI - PMC - PubMed
Estcourt 2017
    1. Estcourt LJ, Malouf R, Trivella M, Fergusson DA, Hopewell S, Murphy MF. Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No: CD011305. [DOI: 10.1002/14651858.CD011305.pub2] - DOI - PMC - PubMed

Associated data