Jansen 2020.

Study characteristics
Methods	Design: RCT, parallel 2‐arm, multicentre, non‐inferiority trial Setting: 3 sites (1 university and 2 general hospitals) in the Netherlands Recruitment: July 2002 to August 2004 Maximum follow‐up: 12 months
Participants	19 adult participants  (≥ 18 years of age) with diagnosed myelodysplasia according to the French‐American‐British classification and dependent on RBC transfusion (e.g. who had ≥ 1 RBC transfusion recently)   Liberal group: n = 9; mean (SD) age = 74.9 (range 66 to 80) years Restrictive group: n = 10; mean (SD) age = 75.7 (range 52 to 91) years
Interventions	Liberal group: used Hb transfusion trigger < 6.0 mmoL/L (< 9.7 g/dL) Restrictive group: used Hb transfusion trigger < 4.5 mmoL/L (< 7.3 g/dL)
Outcomes	Primary endpoint: physical fatigue, measured with the Multidimensional Fatigue Inventory
Notes	Trial registration (post hoc, 2005): ISRCTN43616311 Trial funding: no information COI statement by investigators: "the authors have no conflict of interest to declare"
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No information provided
Allocation concealment (selection bias)	Unclear risk	No information provided
Blinding of participants and personnel (performance bias) Objective outcomes	Low risk	Blinding of personnel for this intervention is not feasible, but in our view, for objective outcomes such as mortality (the primary outcome used within this review), we graded risk of bias as 'low'
Blinding of outcome assessment (detection bias) Objective measures	Low risk	Blinding of mortality (the primary outcome used within this review) is not relevant, and we graded risk of bias as 'low' Participants were blinded but physicians and nurses were not
Blinding of outcome assessment (detection bias) Subjective measures	High risk	Participants were reported to be blinded, but this was not tested. Physicians and nurses were not blinded. Quality of life outcomes including fatigue were reported
Incomplete outcome data (attrition bias) All outcomes	High risk	Insufficient data. 1 death in restrictive arm, 2 in liberal arm, but timing not provided. Follow‐up was incomplete "After randomization 6 out of 10 patients (60%) from the restrictive and 5 out of 9 patients (55.5%) from the liberal arm completed or still participated when the study terminated. Reasons of study withdrawal were withdrawal of informed consent (two in the restrictive and one in the liberal arm), death (one in the restrictive and two in the liberal arm) and usage of growth factors (one patient in each arm)"  Thus, the trial's primary outcome data were available for 11/19 participants
Selective reporting (reporting bias)	Unclear risk	Insufficient data; trial registration was done post hoc, and trial report was provided only in the form of a letter
Other bias	Unclear risk	Terminated prematurely "The Temple study was terminated prematurely due to the slow recruitment rate with only 21 patients in three hospitals in 2 years. Patients who were still participating when the study ended, received transfusion therapy according to the guidelines of the local hospital" (Jansen 2020 p 879)