Red blood cell transfusion thresholds in acute leukemia: Current practice and physician perspectives from a national survey
Bibliographic record
Abstract
Abstract Background Red blood cell (RBC) transfusions are part of essential supportive therapy in patients with acute leukemia, where patients often present with anemia and thrombocytopenia. Together these cytopenias increase bleeding risk; however, optimal hemoglobin (Hb) thresholds for RBC transfusion remain undefined, and current recommendations for restrictive strategies (<7 g/dL) are based on low‐certainty, indirect evidence. Study Design and Methods A national web‐based survey was distributed to 43 physicians (24 centers, Canada) to assess current RBC transfusion practice in patients with acute leukemia, perceptions of a liberal threshold (11 g/dL) in the context of a clinical trial, and feasibility considerations. The survey included categorical responses and open‐text fields. Results Of 38 eligible physicians, 34 responded (89%). For stable, non‐bleeding patients receiving induction chemotherapy, 27/34 (79%) used a Hb threshold of 7 g/dL, 6/34 (18%) used 8 g/dL, and 1/34 (3%) used 9 g/dL. Fourteen (14/34, 41%) respondents indicated that a Hb threshold of 11 g/dL was reasonable for the liberal arm of a clinical trial, while 20/34 (59%) did not. For such a trial, 32/34 (94%) would consider enrolling patients in the trial and 2/34 (6%) would not. Discussion A Hb threshold of 7 g/dL was most reported as standard‐of‐care. Most respondents supported enrolling their patients in a clinical trial comparing a liberal RBC transfusion strategy of 11 g/dL with standard‐of‐care. The feasibility of 11 g/dL should be tested with clear justification, appropriate study outcomes, and attention to safety risks and resource demands.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".