Table 2.

Important questions that need answers in optimizing transfusion support for patients with MDS

Red cell transfusion
1. To what degree does anemia (hemoglobin below the reference range, a laboratory result) need to be corrected to see clinical benefit?
2. When should RBCs be transfused in MDS? What are the optimal hemoglobin thresholds and targets? Are they applicable to all patients, or are there subgroups, such as older patients or those with cardiovascular or respiratory comorbidities, who need special consideration?
3. What is the optimal RBC transfusion schedule? Is a more stable hemoglobin better (should we aim to avoid the peaks and troughs of hemoglobin), and if so, why, and how can we achieve it?
4. What is the optimal RBC product for transfusion in MDS (eg, improved oxygen delivery or lifespan, or degree of RBC antigen matching)?
Platelet transfusion
5. Does degree of thrombocytopenia correlate with health-related QoL? Are there outcomes other than bleeding that are important?
6. To what degree does thrombocytopenia (platelet count below the reference range, a laboratory result) need to be corrected to see clinical benefit?
7. What should be the recommended platelet transfusion thresholds and targets? Are they applicable to all patients, or are there subgroups who need special consideration?
8. What is the optimal platelet product for transfusion in MDS? How can platelet wastage (related to short shelf-life) be minimized?
9. What alternatives to platelet transfusions can be used to reduce bleeding?
All transfusions
10. What transfusion-related outcomes matter to patients, and how can they be measured (eg, using patient-reported outcomes) and prioritized?
11. How can patients be more meaningfully involved in transfusion decision-making, the transfusion process, and monitoring of transfusion outcomes, including adverse events?
12. What tools should we use to measure clinical need for and outcomes of transfusion?
13. What are the clinical and community burdens (including costs and complications) of anemia, thrombocytopenia, and transfusion in MDS?
14. How can the outpatient transfusion process be improved to optimize the patient experience, streamline health care delivery, and reduce costs?
15. Is home transfusion an option, and if so, when and for which patients?