Haematology

Melphalan dosing in autologous stem cell transplant. Should we still dose adjust for older patients? (2026)

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Type of publication:

Conference abstract

Author(s):

Lloyd R.; McIlroy G.; Odusanmi S.; Litt E.; Swart-Rimmer I.; Shafeek S.; Jouni H.; Ahmad H.; Smith L.; Wandroo F.; Ferguson P.

Citation:

British Journal of Haematology. Conference: 66th Annual Scientific Meeting of the British Society for Haematology. Liverpool United Kingdom. 208(Supplement 1) (pp S48), 2026. Date of Publication: 01 Apr 2026.

Abstract:

Background: High dose melphalan with autologous stem cell transplant (ASCT) has formed the basis of consolidation therapy in newly diagnosed multiple myeloma for around 2 decades. In the UK, patients deemed fit for transplant are prescribed either 200 mg/m2 (HImel) or 140 mg/m2 (INTmel) of melphalan based on renal function or age. As populations remain fit into older age, more patients >=65 have been treated with 200 mg/m2 melphalan. There is a lack of evidence base in this population. Analysis aims to determine if there is any difference in efficacy and toxicity in treating patients >=65 with high dose melphalan in a ASCT.
Method(s): Patients with multiple myeloma treated with single agent melphalan ASCT between 2013 and 2023 were included in data collection. Patients undergoing second or tandem autologous transplants were excluded. Dosage of melphalan was decided by the clinician at the time of review. Primary endpoints were PFS and OS, secondary endpoints were toxicity and length of hospital stay.
Result(s): 679 patients were eligible with an average age of 61.14 years. A total of 446 patients received HImel with 85 of these >=65. 232 patients received INTmel with 189 of these >=65. 20 patients were admitted to ITU (2.9%), 4 patients were >=65 with 2 receiving HImel and 2 receiving INTmel. 6 patients (0.88%) died from transplant related complications. 3 of these patients were <65 and received HImel. 3 patients were >=65 and 1 received HImel. There was a significant difference in the length of admission for the <65 HImel group compared to the >=65 HImel group (18.1 vs 21.2days, p value=000286). This difference was not replicated in the INTmel group 21.3 vs 21days. (p-value 0.404328). Overall, there was a statistically significant shorter length of stay for the <65 cohort compared with the >=65 cohort (p value 0.00057). There was no statistically significant difference in overall survival between the groups (<64 HImel 88 months, <65 INTmel 74.3 months, >=65 HImel 74.71 months, >=65 INTmel 73.7 months). There was no significant difference in PFS between the groups (<65 HImel 53.8 months, <65 INTmel 50.4, >=65 HImel 57.46, >=65 42.09 months).
Conclusion(s): The study demonstrates that there is no OS or PFS advantage with treating older patients with high dose melphalan. There were longer hospital stays associated with increasing age. Patients who present older, but still fit for transplant have little evidence on the best way to proceed with treatment.

DOI: 10.1111/bjh.70471

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A meta-analysis on vitamin D deficiency in patients with sickle cell disease (2026)

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Type of publication:

Conference abstract

Author(s):

*Alawad M.

Citation:

British Journal of Haematology. Conference: 66th Annual Scientific Meeting of the British Society for Haematology. Liverpool United Kingdom. 208(Supplement 1) (pp S90), 2026. Date of Publication: 01 Apr 2026.

Abstract:

Vitamin D Deficiency (VDD) is reported to be more frequent with serious clinical outcomes in patients with Sickle Cell Disease (SCD). There is a wide disparity in data in the existing literature regarding the prevalence and risk of VDD in patients with SCD. These data require further summary and analyses for better accuracy. This review aimed to assess the association between VDD and SCD, and was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline/PubMed, World Health Organization Virtual Health Library, ScienceDirect, and Google Scholar were used for the systematic search. A random effects model was used to estimate the pooled prevalence, Risk Ratio (RR), and Standardized Mean Difference (SMD) estimates with the corresponding 95% Confidence Interval (CI) using OpenMeta Analyst software version 10.10 (Tufts Medical Center, Boston, MA, USA). Twenty-five studies fulfilled the eligibility criteria. The prevalence of VDD among patients with SCD was 63.8% (95% CI 52.5-75.1). The risk of VDD among patients with SCD was more than two times that of the general population (RR = 2.129; 95% CI 1.024-4.423; p < 0.001). Serum vitamin D levels were significantly lower in SCD patients than in their controls (SMD = -1.883: 95% CI -3.006 to -0.760; p < 0.001). This review provides a comprehensive view of the association between vitamin D status and SCD.

DOI: 10.1111/bjh.70471

Multidisciplinary team stakeholder event driving development of a novel Haemolytic Disease of the Fetus and Newborn (HDFN) national database for improving clinical outcomes of pregnancy affected by alloimmunisation (2024)

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Type of publication:

Conference abstract

Author(s):

Wilkes N.; Jeffs B.; Morton S.; Rogers L.; *Shields J.; Graham S.; Young B.; Asquith B.; O'Shea M.; McBride C.; Wilkes C.; Hazell M.

Citation:

Transfusion Medicine. Conference: 41st Annual Scientific Meeting of the British Blood Transfusion Society. Glasgow United Kingdom. 34(Supplement) (pp 37-38), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Introduction: HDFN is caused by incompatibility between maternal and fetal red cells, stimulating maternal antibody formation and attacking antigen positive fetal red cells, causing haemolysis (Poole and Daniels, 2007). Severity ranges from mild symptoms of jaundice & anaemia to fatal haemolysis (RCOG, 2014). Scientific advances including anti-D prophylaxis and fetal genotyping have improved clinical care and reduced the occurrence of HDFN (BSH, 2016). Guidelines recommend regularly monitoring maternal blood samples during pregnancy to determine antibody formation and titration, identifying any potential risk to the fetus, thus informing clinical decisions and intervention (BSH, 2016). Reviewing guidelines through evidence base analysis is best for patients, ensuring appropriate management plans. NHSBT historically collected data on outcomes of pregnancies with clinically significant alloantibodies. This project aims to launch a novel data collection platform populating a national pregnancy outcomes database ensuring best practice, prevention and treatment in HDFN. Stakeholder engagement and collaboration is essential, here we present the insights gained and the next steps. Method(s): Stakeholders were surveyed prior to the event to inform current practice and guide the face-to-face event agenda. Continuous improvement tools (including Kano analysis) were employed to facilitate guided evaluation and re-design of the current questionnaire & novel digital platform needs. Stakeholders were split into groups with various professional backgrounds allowing different perspectives to be sought. Following the event attendees had access to the collaborative whiteboard tool, Miro, to further understand challenges and requirements. Results and Discussion: Stakeholder output was key to redesigning a user-friendly questionnaire and drive development of a novel digital platform to promote national uptake. Multidisciplinary team collaboration of clinical, laboratory and operational colleagues across organisations gained helpful intel enabling patient focussed outcomes. This approach enabled open discussions capturing ideas to frame service development. Utilisation of the Kano model was an insightful way of understanding user requirements. Conclusion(s): The expanding dataset will be used to inform future guidelines by questioning which pregnancies are at higher risk of HDFN. Increased information aids in providing optimal care to mothers and their babies. Usage of large datasets to benefit patient outcomes are key strategic priorities within Transfusion 2024 (Stanworth et al, 2023).

DOI: 10.1111/tme.13084

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Incidence and Survival Outcomes of Primary Parotid Follicular Lymphoma (PPFL): a Seer-Based Retrospective Analysis (2025)

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Type of publication:

Conference abstract

Author(s):

Backer G.; *Arunachalam J.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1214-1215), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary malignant lymphomas of the parotid glands are rare, estimated to account for just 0.6% to 5% of all tumors of the parotid gland. Primary Parotid Follicular Lymphoma (PPFL) is a rare subtype of non-Hodgkin lymphoma (NHL) originating in the parotid gland, often associated with autoimmune disorders such as Sjogren's syndrome. Due to its low incidence, comprehensive population-based studies are scarce, limiting our understanding of epidemiological factors associated with PPFL and how they impact survival outcomes. Aims Using a large, population-based cancer registry, we aimed to evaluate the incidence trends and survival patterns of PPFL for the past 20 years in the US. Methods We conducted a retrospective population-based study utilizing data between 2000-2021 from the SEER (Surveillance, Epidemiology, and End Results) database. SEER is a program of the National Cancer Institute that collects epidemiological and survival data from cancer registries across the United States. We identified and extracted data from patients diagnosed with PPFL using ICD codes specific for primary tumors of the parotid gland (C07.9) and for follicular lymphoma (ICD codes 9690, 9691, 9695, 9698). Demographic data collected included year of diagnosis, age, sex, race, and area of residence. Incidence rates (IR) were calculated per 100,000 population and were age adjusted to the US standard population using SEER*stat 8.4.4. Using GraphPad Prism software, Kaplan-Meier survival analysis was done to calculate overall survival (OS) and cancer specific survival (CSS). Log rank (Mantel-Cox) test was used to compare survival outcomes between different groups. Results 793 patients with primary parotid follicular lymphoma were identified. 52% were male. 56% were older than 65 years at the time of diagnosis. 79% of patients were white, 10% were Hispanic, and 5% were black. 18% of patients had metastatic disease at initial presentation. IR was 0.050 (SE 0.002, 95% CI 0.045-0.055) for the years 2000-2010 and 0.036 (SE 0.002, 95% CI 0.032-0.040) from 2011 to 2021. Incidence was 29.7% higher in males compared to females with p = 0.0001(IR 0.048 vs 0.037, respectively). IR was 0.049 amongst white patients (SE 0.002, 95% CI 0.046 – 0.054), 0.021 amongst black patients (SE 0.003, 95% CI 0.015 – 0.029), and 0.031 amongst hispanic patients (SE 0.004, 95% CI 0.024-0.038). Patients between the ages of 75-79 years had the highest IR of 0.241 (SE 0.024, 95% CI 0.197- 0.293). Median overall survival (mOS) was 174 months. 5-year and 10-year CSS was 90% and 84%, respectively. mOS was 180 months in patients who received chemotherapy. mOS was 106 months in adults older than 65 years, compared to those younger (p<0.0001). White patients had the poorest mOS of 161 months (p=0.0042). There was no statistically significant difference in survival outcome based on gender. mOS was 109 months in patients residing in non metropolitan counties compared to mOS of 187 months in patients residing in metropolitan counties (p=0.0005). Summary/Conclusion PPFL primarily affects older adults, with high incidences in males and white patients. Though CSS rates are generally favorable, overall survival was found to be worse in white patients, adults aged > 65, and people residing in non metropolitan counties. These differences highlight potential disparities in disease outcomes and suggest the need for future research into factors influencing survival and access to care for patients with PPFL.

DOI: 10.1002/hem3.70152

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Exploring Disparities in Survival Outcomes of Primary Cardiac Diffuse Large B-Cell Lymphoma (DLBCL): a Seer Database Analysis (2025)

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Type of publication:

Conference abstract

Author(s):

Arvind S.; Shaikh G.; *Arunachalam J.; Naagendran M.S.; Meleveedu K.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 3452-3453), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary Cardiac Diffuse Large B-cell lymphoma (DLBCL) representing only 1.3% of cardiac tumors and 0.5% of extranodal lymphomas is an uncommon but aggressive malignancy that exclusively involves the heart or the pericardium. Favorable clinical outcomes depend on early detection and timely treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Little research currently exists on the impact of healthcare access, socioeconomic and demographic factors on survival rates in primary cardiac DLBCL. Aims This study aims to provide an overview of survival outcomes of primary cardiac DLBCL and their association with demographic and clinical factors. Methods We collected data from SEER (Surveillance, Epidemiology, and End Results), which is a program of the National Cancer Institute (NCI) with statistical information on cancer incidence and survival in the United States. From the Research plus data (17 registries, 2000 – 2021), we extracted patients diagnosed with Diffuse large B-cell lymphoma (DLBCL) using the ICD code 9680/3 and having the primary cancer site as heart using code C38.0. Analysis was stratified based on age, sex, race, marital status, median household income and residency. Survival analysis was done with Graphpad Prism software, and survival outcomes were compared using the Log-rank test. Kaplan-Meier curves were used to visualize the data. Results 134 patients with cardiac DLBCL were identified. 64% of the patient population was 65 and older at diagnosis. 56% males and 44% females. 64% White, 14% Hispanic, 5% Black. 92% of patients lived in counties in metropolitan areas with a population ranging from 250,000 to 1 million. The marital status distribution at the time of diagnosis was as follows: 18% were single (never married), 16% were widowed, 4% were divorced, 2% were separated, 0.75% were in a domestic partnership and 54.5% were married. 72% of patients received chemotherapy, and 10% received external beam radiation therapy. Median overall survival (mOS) for primary cardiac DLBCL was 42 months. Cancer-specific survival (CSS) was 130 months. mOS was 144 months in patients under 65 years, and mOS was 26 months in patients aged 65 and older with p value=0.0010 (HR 2.402, 95% CI 1.470 to 3.926). In stage I disease, mOS was 144 months in < 65 and 33.5 months in 65+ (p = 0.0157). In stage IV, mOS was only 9 months in the 65+ age group, compared to those younger with p = 0.0254. mOS were 109 months in those who were married at the time of diagnosis, compared to a mOS of 25 months in those who were not (p value = 0.0030, HR 0.4825 95% CI 0.2867 to 0.8118). No statistically significant difference was found in overall survival when stratified based on sex, race, residency or median household income. Summary/Conclusion While the median cancer-specific survival of cardiac DLBCL was excellent (~ 10 years), the median overall survival was noted to be significantly lower (3.5 years), highlighting non-cancer causes of mortality. However, our analysis shows that advanced age (>65 yrs) has a significant negative impact on survival. While marital status seemed to be associated with better survival, reflecting the role of social support during cancer care, a firm conclusion requires understanding of additional factors. Future studies should explore the factors contributing to the non-cancer causes of mortality in cardiac DLBCL and poorer survival outcomes in the elderly to assist develop strategies to improve outcomes for this subset.

DOI: 10.1002/hem3.70152

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Epidemiological and Survival Trends of Alk-Positive Large B-Cell Lymphoma: a Seer (Surveillance, Epidemiology, and End Results) Study (2025)

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Type of publication:

Conference abstract

Author(s):

*Arunachalam J.; Meleveedu K.

Citation:

HemaSphere. Conference: 30th Congress of the European Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1319-1321), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Anaplastic lymphoma kinase-positive (ALK+) large B-cell lymphoma (LBCL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL), representing < 1% of all DLBCLs. Tumor growth is driven by ALK gene rearrangements which lead to proto-oncogene activation. Unlike ALK-positive anaplastic large-cell lymphoma (ALCL), ALK+ LBCL shows plasmablastic immunophenotype and often lacks typical T cell (CD2, CD3) and B-cell (CD20, CD79a) markers. It is known to be more aggressive than typical DLBCL due to limited response to conventional systemic chemotherapies like R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), with a dismal 5-year OS of 8% in advanced stage disease. Off-label use of ALK inhibitors has demonstrated encouraging results in multiple case studies. Aims This study aims to analyze the incidence trends, and survival outcomes of ALK+ LBCL using the Surveillance, Epidemiology, and End Results database. SEER provides population-based data on cancer incidence, survival, and treatment outcomes by compiling various cancer registries across the U.S. Methods We conducted a retrospective population-based study between 2010-2021 utilizing the SEER database. Using ICD code 9737/3, we identified patients diagnosed with ALK+ LBCL. Demographic data, including age, sex, race, and stage, were collected. Incidence rates (IR) were calculated per 100,000 and age adjusted to the US standard population. Kaplan-Meier survival analysis was performed using GraphPad Prism to estimate overall survival (OS) and cancer specific survival (CSS). Log rank test was used to detect factors associated with survival outcomes. Results A total of 58 cases of ALK+ LBCL were included. IR was 0.0049 (SE 0.0010, 95% CI 0.0031-0.0073) during the years 2010-2015 and 0.0067 (SE 0.0011, 95% CI 0.0047-0.0094) from 2016-2021. IR was 0.0025 (SE 0.0007, 95% CI 0.0013-0.0044), 0.0035 (SE 0.0007, 95% CI 0.0022-0.0053), 0.0028 (SE 0.0008, 95% CI 0.0015-0.0049), and 0.0052 (SE 0.0015, 95%CI 0.0027-0.0091) in the age groups <20 years, 20-44 years, 45-64 years, and 65+ years respectively. Incidence rate ratio (IRR) was 4.08 (95% CI 2.08 – 7.98) when comparing males and females, indicating that incidence rate in males was 4 times higher than in females. 65% of patients presented with advanced stage disease at the time of diagnosis. Median time from diagnosis to treatment was 13 days. mOS median overall survival was 101 months. The 1-year and 10- year CSS rates were 86%, and 68% respectively. mOS was 53 months for those with advanced stage disease at initial presentation. mOS was 17 months for ages >65 years (p=0.0002), compared to those aged less than 65 years. In Ann Arbor stage I disease, mOS was 144 months in patients < 65 years and 33.5 months in 65+ age group (p = 0.0157). In Ann Arbor stage IV disease, mOS was only 9 months in 65+ age group with p value of 0.0254 when comparing with the younger age group. There was no statistically significant difference in survival outcomes based on sex, and race. Summary/Conclusion This is one of the largest retrospective studies on ALK+ LBCL. We found that incidence of anaplastic lymphoma kinase-positive large B-cell lymphoma is more common in males and adults older than 65. Survival outcomes continue to be poor, especially in older adults. Further multicenter research is warranted to explore the genomic framework and discover novel combination therapies, to improve patient outcomes.

DOI: 10.1002/hem3.70152

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Testing for t(3;8) in MYC/BCL6 re-arranged large B cell lymphoma identifies a high risk subgroup with inferior survival (2024)

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Type of publication:
Journal article

Author(s):
Maybury, Bernard Douglas; James, Lisa Jane BSc (Hons); Phillips, Neil; Venkatadasari, Indrani; Qureshi, Iman; Riley, James William Elliot; Talbot, Georgina; Moosai, Shivir; Giles, Hannah Victoria Dr; Chadderton, Nicola Mrs; Dowds, James; Rakesh, Pallav; Crosland, Henry; Haslam, Aidan; *Lane, Sarah; Vega Gonzalez, Monica; Davies, David; *Cherian, George; Shenouda, Amir; Kaudlay Sathyanarayana, Praveen Kumar; Starczynski, Jane; Rudzki, Zbigniew; Chaganti, Sridhar

Citation:
Blood. 2024 Apr 22.

Abstract:
A reciprocal t(3;8) BCL6::MYC fusion is common in large B cell lymphoma (LBCL) with MYC and BCL6 disruption. These pseudo-double hit cases are not adverse, whereas t(3;8) negative MYC/BCL6 lymphoma has an inferior prognosis relative to other MYC-rearranged LBCL.

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Retrospective multicentre study comparing survival outcomes in chronic lymphocytic leukaemia (CLL) with genetic risk stratification (2023)

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Type of publication:Conference abstract

Author(s):Qureshi I.; Mandal A.; Foster N.; Rose S.; Sharma K.; McIlroy G.; *Cherian G.; *Lane S.; Wandroo F.; Talbot G.; Pemberton N.; Parry H.; Moss P.; Paneesha S.

Citation:British Journal of Haematology. Conference: 63rd Annual Scientific Meeting of the British Society for Haematology. Birmingham United Kingdom. 201(Supplement 1) (pp 67-68), 2023. Date of Publication: April 2023.

Abstract:Purpose: This retrospective West Midlands multicentre study of CLL patients was conducted to review results of genetic testing in CLL patients and impact on survival. Method(s): 349 patients across the West Midlands were included in this retrospective study collected between December 2018 and March 2022. Clinical centres were asked to obtain data relating to the type and number of lines of treatment, overall response and reported genetic abnormalities. Treatment and response were categorised as per international workshop on chronic lymphocytic leukaemia (iwCLL) criteria.1 Genetic testing comprised fluorescence in situ hybridisation (FISH) for copy number abnormalities of 17p &11q, IgHV mutation status and Oxford Gene Technology CLL Next-Generation Sequencing (NGS) Panel to detect sequence variants in key genes associated with CLL (including NOTCH1, SF3B1, BIRC3, ATM and TP53). Patients were risk stratified into good, poor or not poor risk categories as per Rodriguez-Vicente et al.2 Statistical Analysis and Results: For 349 patients analysed, 143 (41%) patients were under active surveillance, and 206 (59%) patients received 1st line treatment. Out of the 206 patients that received 1st line treatment, 92 (44%) patients proceeded to 2nd line treatment, 31 (15%) patients proceeded to 3rd line treatment and 21 (10%) of patients required treatment beyond 3rd line Within the poor risk category, 173 patients were identified with 38 had TP53 deletion or mutation and 135 patients had other poor risk mutations such as NOTCH1, SF3B1, ATM. Statistical analysis did not show a difference in survival either from the diagnosis or from the date of NGS sample in the two groups of high-risk patients. Conclusion(s): The data identifies a cohort of patients with poor outcome that are negative for TP53 mutation, highlighting the importance of NGS in CLL patients at the point of treatment.

Assembly of alternative prothrombinase by extracellular histones initiate and disseminate intravascular coagulation (2021)

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Type of publication:
Journal article

Author(s):
Abrams, Simon Timothy; Su, Dunhao; Sahraoui, Yasmina; Lin, Ziqi; Cheng, Zhenxing; Nesbitt, Kate; *Alhamdi, Yasir; Harrasser, Micaela; Du, Min; Foley, Jonathan; Lillicrap, David; Wang, Guozheng; Toh, Cheng-Hock

Citation:
Blood; 2021 Jan 7;137(1):103-114

Abstract:
Thrombin generation is pivotal to both physiological blood clot formation and pathological development of disseminated intravascular coagulation (DIC). In critical illness, extensive cell damage can release histones into the circulation, which can increase thrombin generation and cause DIC, but the molecular mechanism is not clear. Typically, thrombin is generated by the prothrombinase complex, comprising activated factor X (FXa), activated co-factor V (FVa) and phospholipids to cleave prothrombin in the presence of calcium. In this study, we found that in the presence of extracellular histones, an alternative prothrombinase could form without FVa and phospholipids. Histones directly bind to prothrombin fragments F1 and F2 specifically, to facilitate FXa cleavage of prothrombin to release active thrombin, unlike FVa which requires phospholipid surfaces to anchor the classical prothrombinase complex. In vivo, histone infusion into mice induced DIC, which was significantly abrogated when prothrombin fragments F1+F2 were infused prior to histones, to act as decoy. In a cohort of intensive care unit (ICU) patients with sepsis (n=144), circulating histone levels were significantly elevated in patients with DIC. These data suggest that histone-induced alternative prothrombinase without phospholipid anchorage may disseminate intravascular coagulation, and reveal a new molecular mechanism of thrombin generation and DIC development. In addition, histones significantly reduced the requirement for FXa in the coagulation cascade to enable clot formation in Factor VIII and IX-deficient plasma, as well as in Factor VIII-deficient mice. In conclusion, this study highlights a novel mechanism in coagulation with therapeutic potential in both targeting systemic coagulation activation as well as in correcting coagulation factor deficiency.

Preoperative anemia and outcomes in cardiovascular surgery: systematic review and meta-analysis (2019)

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Type of publication:
Systematic Review

Author(s):
*Padmanabhan, Hari; Siau, Keith; *Curtis, Jason; Ng, Alex; Menon, Shyam; Luckraz, Heyman; Brookes, Matthew J

Citation:
The Annals of Thoracic Surgery. Dec 2019; vol. 108 (no. 6); p. 1840-1848

Abstract:
BACKGROUND Pre-operative anemia is common in patients scheduled for cardiac surgery. However, its effect on postoperative outcomes remains controversial. This meta-analysis aimed to clarify the impact of anemia on outcomes following cardiac surgery.METHODS A literature search was conducted on MEDLINE, Embase, Cochrane, and Web of Science databases. The primary outcome was 30-day postoperative or in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), stroke, blood transfusion, and infection. A meta-analytic model was used to determine the differences in the above postoperative outcomes between anemic and non-anemic patients. RESULTS Out of 1103 studies screened, 22 met the inclusion criteria. A total of 23624 (20.6%) out of 114277 patients were anemic. Anemia was associated with increased mortality (odds ratio [OR] 2.74, 95% confidence interval [CI] 2.32-3.24; I2=69.6%; p<0?001), AKI (OR 3.13, 95% CI 2.37-4.12; I2=71.1%; p<0?001), stroke (OR 1.46, 95% CI 1.24-1.72; I2=21.6%; p<0?001), and infection (OR 2.65, 95% CI 1.98-3.55; I2=46.7%; p<0?001). More anemic patients were transfused than non-anemic (33.3 versus 11.9%). No statistically significant association was found between mortality and blood transfusion (OR 1.35, 95% CI 0.92-1.98; I2=83.7%; p=0.12) but we were not able to compare mortality with or without transfusion in those who were or were not anemic. CONCLUSIONS Preoperative anemia is associated with adverse outcomes following cardiac surgery. These findings support the addition of preoperative anemia to future risk prediction models, and as a target for risk modification.

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