Analysis of transfusion practices and efficacy in pediatric acute leukemia: a single-center study

This article aims to analyze current red blood cell (RBC) transfusion practices and evaluate the efficacy and safety of different transfusion thresholds in patients with pediatric acute leukemia (AL) at a single center. Clinical data from 220 children with AL who received RBC transfusions at the Third Xiangya Hospital of Central South University between January 1 and December 31, 2023, were retrospectively collected. Patients were divided into three groups based on pre-transfusion hemoglobin (Hb) levels: a low Hb group (≤ 60 g/L, n = 43), a medium Hb group (61–70 g/L, n = 137), and a high Hb group (> 70 g/L, n = 40). Basic clinical characteristics, Hb increment (ΔHb), anemia symptom improvement rate, and incidence of transfusion-related adverse reactions were compared among the groups. The median pre-transfusion Hb threshold was approximately 66 g/L across all subgroups based on age, disease subtype, presence of co-existing infection, or anemia symptoms, with no statistically significant differences observed among the groups (P > 0.05). No significant differences were identified among the three groups regarding transfusion dose or ΔHb (median: 15 g/L, 16 g/L, and 17 g/L, respectively; P = 0.581). Among the 55 children with pre-transfusion anemia symptoms, symptom improvement rates also showed no significant differences among the three groups (P > 0.05). The overall incidence of transfusion-related adverse reactions was 0.91% (2/220), with no differences among the groups. The results suggest that RBC transfusions effectively increase Hb levels and alleviate symptoms across different threshold groups, with a good safety profile. No clear association was observed between transfusion thresholds and efficacy or safety.