How do Red Blood Cell Transfusions Impact Quality of Life in Patients with Acute Myeloid Leukemia: A Scoping Review

Abstract

This scoping review evaluates the impact of red blood cell (RBC) transfusions on quality of life (QoL) in adults with acute myeloid leukemia (AML) and compares the effect of restrictive versus liberal transfusion thresholds. Literature was searched in PubMed, Web of Science, and the University of Alberta library databases using keywords “blood transfusions,” “quality of life,” and “acute myeloid leukemia.” This review includes studies published between 2015-2025. Ultimately after 103 retrieved literature only two studies met eligibility criteria. The first study found that liberal transfusion thresholds (8-9 g/dL) improved physical QoL, as measured by the EORTC QLQ-C30. The second study suggested that liberal transfusions favoured QoL particularly in the second cycle. It also led to more transfusions and a higher incidence of complications such as infections and thrombotic events. The restrictive cohort in this study showed more symptom-driven transfusions which could indicate that liberal strategies may improve symptom control. Both studies suggest that liberal transfusion thresholds may improve physical symptoms like fatigue, but the trade-off includes an increased risk of complications. Both studies were also limited by their primary focal point of physical aspects of QoL. This led to negligence in psychological and social domains. These findings highlight the need for further research into the emotional, cognitive, and social impacts of RBC transfusions in AML patients. While liberal transfusions may offer some improvement in fatigue and physical QoL, they also pose a higher risk of complications. Larger studies are needed to validate these findings and to better understand the broader impact of RBC transfusions on all aspects of QoL in AML patients.