Overview
This pilot study aims to gather preliminary evidence on how different hemoglobin levels impact blood biomarkers related to bleeding. The feasibility of conducting a future larger clinical trial will also be assessed. Red blood cell transfusions are part of the standard of care for patients with leukemia. This study evaluates two transfusion strategies: one that maintains hemoglobin levels above the standard-of-care threshold, reflecting current routine practice; and another that maintains hemoglobin levels above 110 g/L, which is closer to the normal hemoglobin range. The normal hemoglobin range is 120-160 g/L for females and 140-180 g/L for males. Raising hemoglobin levels closer to normal values may reduce bleeding risk.
Eligibility
Inclusion Criteria:
- ≥18 years old.
- Inpatient
- Diagnosis of acute myeloid leukemia or acute lymphocytic leukemia.
- Less than 5 days have elapsed since the start of induction chemotherapy treatment.
- Hemoglobin at enrolment is under 130 g/L.
Exclusion Criteria:
- Failure to provide informed consent.
- Unwilling to receive blood transfusions.
- Life expectancy <72 hours.
- Undergoing palliative chemotherapy.
- Requires specialized blood products (e.g., antigen-matched, irradiation, etc.).
- Diagnosis of acute promyelocytic leukemia.
- Diagnosis of hyperleukocytosis (a white blood cell count exceeding 100 × 10^9/L).
- Diagnosed with coagulopathies or ongoing treatment with therapeutic anticoagulants, aspirin or nonsteroidal anti-inflammatory drugs (history of inherited or acquired coagulation disorder, known hemolytic disease, INR > 1.5)
- Evidence of iron overload (ferritin >800 ng/mL, transferrin saturation >80%) .