Factors influencing intertransfusion interval in children with transfusion dependent thalassemia

We are writing to comment on the author Ma et al.’s article “Determinants of intertransfusion interval in children with transfusion-dependent thalassemia: a retrospective single-center cohort study in China” (1). We commend the writers for their important work in this area. Transfusion-dependent thalassemia (TDT) is a severe hereditary disease that requires lifelong, frequent red blood cell (RBC) transfusions to maintain adequate hemoglobin levels and support normal growth and development in affected children. This study provides an insight into the factors that affect intertransfusion intervals in TDT, particularly through its analysis of RBC products characteristics and thalassemia genotype severity. These findings will surely help researchers in optimising transfusion efficacy and reducing complications, including iron overload, by making use of personalized transfusion schedules. Overall, the study proves to be very valuable in improving the standard of care for TDT patients. However, some aspects require further explanation.

In the article, the authors divided the intertransfusion interval based on the median value, thereby converting a continuous variable into a binary outcome. Such an approach reduces statistical power (2). As extreme variables within each group (e.g., 5 and 17 days in one group, 19 and 50 days in the other) are treated as equivalent, variability is masked and associations are potentially weakened. Dichotomization also alters the relationship between variables and outcomes and limits the robustness of hypothesis testing (3).

Moreover, the authors observed that patients receiving washed red blood cells (WRBC) had shorter intervals between transfusions than those receiving leukoreduced red blood cells (LRBC). However, the study does not explain why certain patients received WRBC while others received LRBC. WRBCs are usually used in routine clinical practice for individuals who are more seriously ill and may naturally need more frequent transfusions. Therefore, rather than being a direct result of the RBC type itself, the observed correlation between RBC product type and intertransfusion interval may be impacted by the severity of the disease (4,5).

Additionally, although the study only included 21 pediatric patients, it examined 392 transfusions for each child. Provided many observations. The t-tests and chi-squared tests are examples of statistical tests that make the assumption that every observation is independent. Transfusions from the same patient are actually connected because they have similar genetic backgrounds, illness courses, and other personal characteristics (5). The analysis should take this into account by using mixed-effects models or other techniques to provide more reliable results.

The authors’ work is highly valuable and praiseworthy, but taking the points discussed above into consideration could strengthen the study’s significance.

Supplementary

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Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.