The threshold for children receiving blood transfusion during stem cell transplants could be safely reduced, according to a UK-led study.
A small pilot feasibility study, organised by NHS Blood and Transplant, was the first test of the question for 20 years.
Some 34 children took part in the RePAST study at four centres in the UK. The children were mostly under treatment for acute lymphoblastic leukaemia or acute myeloid leukaemia.
Some received transfusions when their haemoglobin levels dropped below 80 g/L (the ‘liberal’ arm) while others only received transfusions at lower levels of 65 g/L (‘restrictive’ arm).
Reporting in the British Journal of Haematology, researchers say the patients in the restrictive arm, with the lower threshold, raised no safety concerns and showed no signs of increased fatigue. The trial was a feasibility study, not powered to assess clinical outcomes, and a larger study will be required to fully understand the impact on survival or quality of life.
Researcher Dr Helen New, formerly consultant in paediatric transfusion medicine at NHS Blood and Transplant, said: “The findings support the exploration of more restrictive thresholds for transfusion below 70 g/L in children.
“This is important because blood transfusions have risks and we need to be sure to use blood for transfusion in children only when needed. Larger studies will be needed to see if the findings from our pilot study apply to more children.”
Source:
New HV, Sanderson E, Hopkins V, Thomas H, Gassas A, Adams M, Gibson B, Patrick K, Wynn R, Hoole L, Smethurst H, Lobo-Clarke M, Smith L, Mora A, Stanworth SJ. (2025) “How low can we go? Comparison of liberal and restrictive red cell transfusion thresholds in paediatric allogeneic haematopoietic stem cell transplantation: A randomized multicentre feasibility trial.” British Journal of Haematology, 21 April 2025, doi: 10.1111/bjh.20051.
Link: https://onlinelibrary.wiley.com/doi/10.1111/bjh.20051
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