Transfusion in Malignant Haematological Disease

Patients with haematological diseases are major users of blood components. There are specific considerations relating to the use of red cell transfusion in patients receiving intensive myelosuppressive/myeloablative treatment, including the need to provide a ‘reserve’ in case of severe infection or haemorrhage, and the convenience of having a standard policy for red cell transfusion in the setting of an acute haematology service. The clinical use of recombinant erythropoietin might be considered in several situations in haematology patients, such as delayed erythroid engraftment after allogeneic bone marrow/peripheral blood progenitor cell transplantation, the treatment of anaemia in patients with myelodysplasia, and in the management of Jehovah’s Witnesses with haematological disorders. In general, platelet transfusions are indicated for the prevention and treatment of haemorrhage in patients with thrombocytopenia or platelet function defects. Randomised controlled trials of granulocyte transfusions have been very challenging to undertake and complete.