Red blood cell transfusion in myelodysplastic syndromes: A systematic review

Faculty of Medicine, University of Ottawa/The Ottawa Hospital, Ottawa, Ontario, Canada. University of Toronto, Toronto, Ontario, Canada. The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.

Transfusion medicine (Oxford, England). 2021
PICO Summary


Patients with myelodysplastic syndromes (MDS), (38 studies, n= 11,101).


Red blood cell (RBC) transfusions.


Various comparators including not receiving RBC transfusions, transfusion thresholds, and RBC transfusion prophylactically matched/not matched.


Fourteen studies reported data on survival following diagnosis of MDS, and the majority reported an inverse relationship between RBC transfusion and survival. Three studies found no significant differences in overall survival in MDS patients who received a greater number of RBC transfusions. From the 9 studies reporting on transfusion-related iron overload and its complications, 3 studies found an increased risk including presentations of cardiomyopathy/heart failure, conduction disorders, diabetes and liver disease. Five studies measuring health care utilization related to transfusion found a higher healthcare utilization, including emergency visits and hospitalizations in MDS patients.
Patients with myelodysplastic syndrome (MDS) frequently receive red blood cell (RBC) transfusions for anaemia resulting from ineffective erythropoiesis. While RBC transfusions may rapidly increase haemoglobin values, their impact on clinical and health services outcomes in MDS patients has not previously been summarized. We conducted a systematic review of the literature to evaluate risks and benefits of RBC transfusions in MDS patients. We searched electronic databases (MEDLINE, Embase, CENTRAL, CINAHL) from inception through June 4, 2021 to identify studies reporting data on RBC transfusions in MDS patients. Full text publications that assessed RBC transfusions as an intervention and reported at least one clinical, laboratory, or healthcare outcome associated with transfusion were included. Study characteristics, transfusion information and transfusion-related outcomes were extracted and reported. We identified 1243 original studies, of which 38 met eligibility requirements and were included. Fourteen reported on survival following diagnosis of MDS, with the majority reporting poorer survival among patients receiving or requiring more frequent transfusions. Nine reported on transfusion-related iron overload and its complications. Other outcomes included rates of allo/autoimmunization and adverse transfusion reactions, and healthcare costs incurred by patients with a greater transfusion burden. Only two studies reported on symptom relief following transfusion. This review underscores transfusion dependence as a negative prognostic factor for MDS patients and highlights the paucity of evidence surrounding quality of life and symptom-related outcomes following RBC transfusions in this population. Further study of patient-important outcomes associated with transfusion in MDS patients is warranted to improve therapeutic recommendations and inform resource allocation.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine