Red Blood Cell Transfusion Strategies in Paediatric Leukaemia: Influences on Quality of Life and Survival Outcomes – A Scoping Review

Abstract

Introduction: Haematological malignancies (blood cancers) include leukaemia, lymphomas, and myelomas. These cancers arise from genomic mutations affecting blood-forming tissues or immune system cells often leading to chronic anaemia resulting from the malignancy alone or its treatment regimens. Various treatment modalities can be imposed including, red blood cell (RBC) transfusions. Patient outcomes, which may be measured by survival rates, quality of life (QoL), and the risk of complications related to transfusions, can be influenced by transfusion strategies. Current guidelines emphasise tailored approaches that consider the patient’s overall treatment plan, haemoglobin levels, and clinical condition.

Methods: Articles that included paediatric subjects from 0-18 years old and diagnosed with any subtype(s) of leukaemia and underwent any method of RBC transfusion strategies were included. The review adhered to the Joanna Briggs Institute methodology for conducting scoping reviews, and the PRISMA-ScR extension for systematic reviews and meta-analyses. Following a search strategy across multiple databases, 6 papers were identified and included in the review.

Results: From the six included articles, two articles focused on liberal RBC transfusion strategies and three articles on restrictive and liberal RBC combination transfusion strategies. Results from the included articles reported lesser mortality rates in paediatric administered with liberal transfusion strategies. Evidence relating to QoL outcomes was not substantially reported across the included articles.

Discussion: A liberal RBC transfusion was the commonest undertaken approach in paediatric subjects across the included articles. Nair Manjusha et al., 2018, Kerri Nottage et al., 2013, and Robitaille et al., 2012 concluded that a liberal RBC transfusion strategy was most effective in comparison to restrictive strategies. Most articles reported that a liberal RBC transfusion strategy resulted in less mortality. QoL was not substantially mentioned across the articles. Due to the limited number of articles, results are unclear regarding which strategy is most appropriate.

Conclusion: Results of this review present inconclusive findings regarding which strategy is most appropriate in the management of paediatric subjects diagnosed with haematological malignancies. Although a liberal transfusion strategy reported lesser mortality, increasing literature which rectify the limitations observed across the included articles is required.