NHS Blood and Transplant research on transfusions for paediatric stem cell patients published in the British Journal of Haematology

Trial evidence on when to transfuse anaemic children with bone marrow failure is very limited.

The research is dominated by the findings of one limited randomised trial, set in paediatric intensive care, carried out more than 20 years ago.

Children should be able to cope with less transfusion, and blood transfusions carry risks – so better evidence on when transfusions should be given to children is needed.

To make progress, NHS Blood and Transplant-led researchers set out to test whether different haemoglobin thresholds could safely be carried out for a group of children who need repeated transfusions.

They created a pilot study, the 'RePAST' trial, which enrolled 34 children having stem cell transplants at 4 centres.

Children recruited to the study went into one of 2 arms – transfusions when blood haemoglobin levels reached 80 g/L or transfusions at a more restrictive level of 65 g/L.

Most of the participants had underlying either acute lymphoblastic leukaemia or acute myeloid leukaemia.

There was no evidence that the restrictive arm of 65 g/L was associated with safety concerns or increased fatigue. There was good study recruitment and adherence to the transfusion protocol, with a clinically significant separation in haemoglobin levels between the two arms.

Lead researcher Dr Helen New, who has just retired as a Consultant in Paediatric Transfusion Medicine at NHS Blood and Transplant, said:

"The findings support the exploration of more restrictive thresholds for transfusion below 70 g/L in children. This is important because blood transfusions have risks and we need to be sure to use blood for transfusion in children only when needed. Larger studies will be needed to see if the findings from our pilot study apply to more children."

The results are now published in the British Journal of Haematology. http://doi.org/10.1111/bjh.20051

The study was supported by the NHS Blood and Transplant Clinical Trials Unit (and funded by the NHS Blood and Transplant Trust Fund).

The trial team especially thanked the families and children for taking part and the four participating centres: Bristol Royal Hospital for Children, Royal Hospital for Children Glasgow, Sheffield Children's NHS Foundation Trust, Royal Manchester Children's Hospital.