RBC transfusion in MDS
1. The ideal threshold for Hb transfusion is not known. In patients, typically younger patients undergoing hematopoietic stem cell transplantation, a restrictive threshold of 7gm was considered safe.
2. Reactions- minor febrile reactions, TACO. Whether transfusing fewer units at a time, or more slowly, or accompanied by prophylactic diuretics reduces TACO risk for patients with MDS is not known.
3. Alloimmunization can be a problem upwards of 25%. antibodies to K and the Rh system antigens (especially anti-E) are the most common; therefore, providing RBCs negative for these antigens may be sufficient to minimize alloimmunization for most patients.
4. Iron overload is another problem both due to ineffective.
5. Iron chelation- can reduce transfusion requirements and should be considered early for patients who become transfusion dependent. However, determining who is a candidate for chelation can be difficult; higher-risk patients needing greater transfusion intensity will become iron loaded more quickly but may not benefit from chelation because of their shorter survival.
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