Transfusions

Direct replacement of red blood cells through transfusion is the cornerstone of palliating anemia-related symptoms in MMM. Currently, there are no data to support the routine use of iron chelation therapy for prevention of secondary iron overload in these transfusion-dependent individuals. Indeed, there are no data demonstrating definitive end-organ toxicity from iron overload in MMM patients. Unfortunately, the poor prognosis associated with transfusion dependence in MMM results in a short survival duration, making concerns over long-term effects of iron overload moot.

Platelet transfusions in MMM are less frequently required, but lead to alloimmunization more rapidly than erythrocyte transfusions. Therefore, platelet transfusions in MMM should be limited to hemorrhagic episodes or thrombocytopenia severe enough that risks of spontaneous bleeding are unacceptable (platelet counts <10 X 109/L or higher in clinical scenarios, such as fever).

Figure 49.1 Symptomatic approach to implementing palliative therapies in patients with MMM
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