Red cell transfusion in outpatients with myelodysplastic syndromes: a feasibility and exploratory randomised trial

Optimal red cell transfusion support in myelodysplastic syndromes (MDS) has not been tested and established. The aim of this study was to demonstrate feasibility of recruitment and follow-up in an outpatient setting with an exploratory assessment of quality of life (QoL) outcomes (EORTC QLQ-C30 and EQ-5D-5L). We randomised MDS patients to standardised transfusion algorithms comparing current restrictive transfusion thresholds (80 g/l, to maintain haemoglobin 85-100 g/l) with liberal thresholds (105 g/l, maintaining 110-125 g/l). The primary outcomes were measures of compliance to transfusion thresholds. Altogether 38 patients were randomised (n = 20 restrictive; n = 18 liberal) from 12 participating sites in UK, Australia and New Zealand. The compliance proportion for the intention-to-treat population was 86% (95% confidence interval 75-94%) and 99% (95-100%) for restrictive and liberal arms respectively. Mean pre-transfusion haemoglobin concentrations for restrictive and liberal arms were 80 g/l (SD6) and 97 g/l (SD7). The total number of red cell units transfused on study was 82 in the restrictive and 192 in the liberal arm. In an exploratory analysis, the five main QoL domains were improved for participants in the liberal compared to restrictive arm. Our findings support the feasibility and need for a definitive trial to evaluate the effect of different red cell transfusion thresholds on patient-centred outcomes.

Aristotle and Galen on sex difference and reproduction: a new approach to an ancient rivalry

[I]n contrast to Aristotle's male oriented explanation of procreation the Galenic was 'feminist' inasmuch as both sexes were presented as contributing equally in conception and accordingly both had to experience pleasure... Anatomically, the two sexes were presented in Galenic accounts as complementary, the difference being that the man's genitalia were on the outside and the woman's on the inside. The clitoris was likened to the penis and the ovaries considered 'testicles' or 'stones' that produced seed. The male seed was, it is true, depicted by Galenists as superior in having 'spiritual' qualities lacking in the female, but Galen's reproductive schema was far more egalitarian than Aristotle's. (McLaren, 1985, p. 327)