# Transfusion support and anaemia management

Source: https://onco.cc/technologies/transfusion-support/  
OnCo record `transfusion-support` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Red cell and platelet transfusions, iron and erythropoiesis-stimulating agents keep patients safe through chemotherapy and marrow failure; restrictive thresholds and ESA caution reflect trials showing more is not better.

## Summary

Chemotherapy-induced anaemia affects most patients on myelosuppressive regimens; MDS and leukaemia patients are often transfusion-dependent. Evidence supports restrictive red cell thresholds (7-8 g/dL in stable patients; TRIST, Hb 7 vs 9 in haematologic malignancy) and prophylactic platelet transfusion at 10×10⁹/L (TOPPS showed prophylaxis still helps in most). ESAs (epoetin, darbepoetin) reduce transfusions but increased thromboembolism and mortality in several trials when Hb targets were high, so labels restrict them to palliative chemotherapy with Hb <10 g/dL (2007-08 FDA/EMA actions). IV iron improves ESA response and treats functional iron deficiency. Transfusional iron overload in MDS is treated with chelation (TELESTO). Newer agents: luspatercept and imetelstat (MDS), romiplostim/eltrombopag for chemotherapy-induced thrombocytopenia (off-label; avatrombopag trials), and thrombopoietin agonists after transplant. Blood supply and cost are limiting worldwide; pathogen-reduced platelets and cold-stored platelets are being adopted.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-08
- Tags: gap-fill; supportive
- Principle: Replace or stimulate deficient blood components to prevent symptomatic anaemia, bleeding and infection while avoiding over-transfusion, alloimmunisation and ESA-related thrombosis.
- Strengths: Life-saving in acute leukaemia and transplant; Restrictive strategies proven safe and cheaper; New MDS agents reduce transfusion burden
- Limitations: Blood supply shortages, especially in LMICs; ESA safety restricts use; Iron overload and alloimmunisation with chronic transfusion

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Blood_transfusion
- AABB red cell transfusion guideline 2023: https://doi.org/10.1001/jama.2023.12914
- ASCO/ASH ESA guideline 2019: https://doi.org/10.1200/JCO.18.02142

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Acute myeloid leukaemia in children](https://onco.cc/cancers/aml-paediatric/), [Acute myeloid leukaemia in older or unfit patients](https://onco.cc/cancers/aml-older-unfit/), [Acute promyelocytic leukaemia](https://onco.cc/cancers/apl/), [Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms](https://onco.cc/cancers/cmml/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Higher-risk myelodysplastic syndromes](https://onco.cc/cancers/mds-higher-risk/), [Leukaemia (all types)](https://onco.cc/cancers/leukaemia/), [Lower-risk myelodysplastic syndromes](https://onco.cc/cancers/mds-lower-risk/), [Myelodysplastic syndromes / neoplasms (MDS)](https://onco.cc/cancers/mds/), [Myeloproliferative neoplasms (PV, ET, myelofibrosis)](https://onco.cc/cancers/myeloproliferative-neoplasms/), [Newly diagnosed multiple myeloma, transplant-ineligible](https://onco.cc/cancers/myeloma-transplant-ineligible/), [Primary myelofibrosis](https://onco.cc/cancers/primary-myelofibrosis/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Growth factors: G-CSF and febrile neutropenia prevention](https://onco.cc/technologies/g-csf-growth-factors/)
- drugs: [Darbepoetin alfa](https://onco.cc/drugs/darbepoetin-alfa/), [Epoetin alfa](https://onco.cc/drugs/epoetin-alfa/), [Epoetin theta](https://onco.cc/drugs/epoetin-theta/), [Imetelstat](https://onco.cc/drugs/imetelstat/), [Luspatercept](https://onco.cc/drugs/luspatercept/)
- key papers: [Management of Cancer-Associated Anemia With Erythropoiesis-Stimulating Agents: ASCO/ASH Clinical Practice Guideline Update](https://onco.cc/key-papers/paper-bohlius-j-clin-oncol/), [Red Blood Cell Transfusion: 2023 AABB International Guidelines](https://onco.cc/key-papers/paper-carson-jama/)
- people: [Emil J Freireich](https://onco.cc/people/emil-freireich/)
- terms: [Anaemia](https://onco.cc/terms/anaemia/), [Bone marrow](https://onco.cc/terms/bone-marrow/), [Thrombocytopenia](https://onco.cc/terms/thrombocytopenia/)
- targets: [MPL (thrombopoietin receptor)](https://onco.cc/targets/mpl/)
- trials: [A Study to Evaluate Long-term Safety in Participants Who Have Participated in Other Luspatercept (ACE-536) Clinical Trials](https://onco.cc/trials/nct04064060/), [An Efficacy and Safety Study of Luspatercept (ACE-536) Versus Placebo in Subjects With Myeloproliferative Neoplasm-Associated Myelofibrosis on Concomi](https://onco.cc/trials/nct04717414/), [COMMANDS](https://onco.cc/trials/commands/), [MEDALIST](https://onco.cc/trials/medalist/)

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