Pretransfusion hemoglobin level and mortality in adults with transfusion-dependent β-thalassemia

TO THE EDITOR:

Ineffective erythropoiesis and chronic anemia are the hallmarks of disease in β-thalassemia.¹ Patients presenting with severe anemia and symptoms or those later manifesting poor growth or development or increased morbidity are often maintained on regular transfusion therapy and classified as having transfusion-dependent β-thalassemia (TDT).² Target pretransfusion hemoglobin ranges of 9 to 10 g/dL, 9 to 10.5 g/dL, and 9.5 to 10.5 g/dL have been recommended by various international management guidelines over the past few decades to inform transfusion frequency.^3,4 These ranges have been mainly set by expert opinion, primarily relying on data highlighting the relationship between pretransfusion hemoglobin levels and suppression of erythropoiesis.⁵ Studies on the association between pretransfusion hemoglobin level and long-term mortality...