J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://jh.elmerpub.com

Original Article

Volume 15, Number 2, April 2026, pages 80-89

Evaluating Hemoglobin Thresholds for Blood Transfusions in Oncology Patients Admitted to the Intensive Care Unit

↓ Figure 1. Survival analysis of the ICU patients. Kaplan–Meier survival analysis was conducted to compare survival probabilities across threshold levels, and a statistically significant effect of threshold level on survival was observed (Chi-square = 6.746, df = 2, P < 0.05). The X axis indicates transfusion threshold in relation to time (1 unit of measure = 3 months interval with 0 being 0 to 3 months, 1 being 3 to 6 months, etc.); and the Y axis indicates the survival probabilities (0 to 1 as a proportion value). The lower threshold had a survival probability of 56.4%, and the intermediate threshold had the highest survival of 64.2%. Meanwhile, the higher threshold of 8 or more had the lowest survival of 50.3%.

↓ **Table 1.** Sociodemographic Characteristics and Type of Malignancy in the Study Population
	Transfusion threshold
Hb: hemoglobin.
Age
Average	64.97	67.09	68.50	66.44
Gender
Male
Count	136	102	89	327
% within transfusion threshold	52.1%	62.2%	65.9%	58.4%
% of total	24.3%	18.2%	15.9%	58.4%
Female
Count	125	62	46	233
% within transfusion threshold	47.9%	37.8%	34.1%	41.6%
% of total	22.3%	11.1%	8.2%	41.6%
Race
Other
Count	15	12	3	30
% within transfusion threshold	5.7%	7.3%	2.2%	5.4%
% of total	2.7%	2.1%	0.5%	5.4%
White
Count	225	142	127	494
% within transfusion threshold	86.2%	86.6%	94.1%	88.2%
% of total	40.2%	25.4%	22.7%	88.2%
Black
Count	21	10	5	36
% within transfusion threshold	8.0%	6.1%	3.7%	6.4%
% of total	3.8%	1.8%	0.9%	6.4%
Ethnicity
Non Hispanic
Count	249	157	132	538
% within transfusion threshold	95.4%	95.7%	97.8%	96.1%
% of total	44.5%	28.0%	23.6%	96.1%
Hispanic
Count	12	7	3	22
% within transfusion threshold	4.6%	4.3%	2.2%	3.9%
% of total	2.1%	1.3%	0.5%	3.9%
Type of malignancy
Leukemia
Count	54	32	33	119
% within transfusion threshold	20.7%	19.5%	24.3%	21.2%
% of total	9.6%	5.7%	5.9%	21.2%
Lymphoma
Count	42	35	19	96
% within transfusion threshold	16.1%	21.3%	14.0%	17.1%
% of total	7.5%	6.2%	3.4%	17.1%
Brain cancer
Count	3	2	5	10
% within transfusion threshold	1.1%	1.2%	3.7%	1.8%
% of total	0.5%	0.4%	0.9%	1.8%
Lung cancer
Count	89	56	52	197
% within transfusion threshold	34.1%	34.1%	38.2%	35.1%
% of total	15.9%	10.0%	9.3%	35.1%
Gastrointestinal cancer
Count	78	43	35	156
% within transfusion threshold	29.9%	26.2%	25.7%	27.8%
% of total	13.9%	7.7%	6.2%	27.8%

↓ Table 1. Sociodemographic Characteristics and Type of Malignancy in the Study Population

Transfusion threshold

Hb < 7 (n = 261)

Hb 7–8 (n = 164)

Hb > 8 (n = 135)

Total (n = 560)

Hb: hemoglobin.

Age

Average

64.97

67.09

68.50

66.44

Gender

Male

Count

136

102

327

% within transfusion threshold

52.1%

62.2%

65.9%

58.4%

% of total

24.3%

18.2%

15.9%

58.4%

Female

Count

125

233

% within transfusion threshold

47.9%

37.8%

34.1%

41.6%

% of total

22.3%

11.1%

8.2%

41.6%

Race

Other

Count

% within transfusion threshold

5.7%

7.3%

2.2%

5.4%

% of total

2.7%

2.1%

0.5%

5.4%

White

Count

225

142

127

494

% within transfusion threshold

86.2%

86.6%

94.1%

88.2%

% of total

40.2%

25.4%

22.7%

88.2%

Black

Count

% within transfusion threshold

8.0%

6.1%

3.7%

6.4%

% of total

3.8%

1.8%

0.9%

6.4%

Ethnicity

Non Hispanic

Count

249

157

132

538

% within transfusion threshold

95.4%

95.7%

97.8%

96.1%

% of total

44.5%

28.0%

23.6%

96.1%

Hispanic

Count

% within transfusion threshold

4.6%

4.3%

2.2%

3.9%

% of total

2.1%

1.3%

0.5%

3.9%

Type of malignancy

Leukemia

Count

119

% within transfusion threshold

20.7%

19.5%

24.3%

21.2%

% of total

9.6%

5.7%

5.9%

21.2%

Lymphoma

Count

% within transfusion threshold

16.1%

21.3%

14.0%

17.1%

% of total

7.5%

6.2%

3.4%

17.1%

Brain cancer

Count

% within transfusion threshold

1.1%

1.2%

3.7%

1.8%

% of total

0.5%

0.4%

0.9%

1.8%

Lung cancer

Count

197

% within transfusion threshold

34.1%

38.2%

35.1%

% of total

15.9%

10.0%

9.3%

35.1%

Gastrointestinal cancer

Count

156

% within transfusion threshold

29.9%

26.2%

25.7%

27.8%

% of total

13.9%

7.7%

6.2%

27.8%

↓ **Table 2.** Comorbidities and Complications of the Study Population
	Transfusion threshold
Hb: hemoglobin; COPD: chronic obstructive pulmonary disease.
Comorbidities
Cardiovascular disease
Count	32	24	26	82
% within transfusion threshold	12.3%	14.6%	19.1%	14.6%
% of total	5.7%	4.3%	4.6%	14.6%
Peripheral vascular disease
Count	17	14	9	40
% within transfusion threshold	6.5%	8.5%	6.6%	7.1%
% of total	3.0%	2.5%	1.6%	7.1%
COPD
Count	88	60	48	196
% within transfusion threshold	33.7%	36.6%	35.3%	34.9%
% of total	15.7%	10.7%	8.6%	34.9%
Chronic kidney disease
Count	89	56	41	186
% within transfusion threshold	34.1%	34.1%	30.1%	33.2%
% of total	15.9%	10.0%	7.3%	33.2%
Diabetes
Count	95	45	41	181
% within transfusion threshold	36.4%	27.4%	30.1%	32.3%
% of total	16.9%	8.0%	7.3%	32.3%
Complications
Sepsis
Count	133	59	51	243
% within transfusion threshold	51.0%	36.0%	37.5%	43.3%
% of total	23.7%	10.5%	9.1%	43.3%
Acute kidney injury
Count	130	73	65	268
% within transfusion threshold	49.8%	44.5%	47.8%	47.8%
% of total	23.2%	13.0%	11.6%	47.8%
Respiratory failure
Count	156	74	68	298
% within transfusion threshold	59.8%	45.1%	50.0%	53.1%
% of total	27.8%	13.2%	12.1%	53.1%
Cardiac arrest
Count	18	9	15	42
% within transfusion threshold	6.9%	5.5%	11.0%	7.5%
% of total	3.2%	1.6%	2.7%	7.5%
Heart failure
Count	96	54	49	199
% within transfusion threshold	36.8%	32.9%	36.0%	35.5%
% of total	17.1%	9.6%	8.7%	35.5%
Altered mental state
Count	31	8	11	50
% within transfusion threshold	11.9%	4.9%	8.1%	8.9%
% of total	5.5%	1.4%	2.0%	8.9%
Mechanical ventilator requirement
Count	89	72	71	232
% within transfusion threshold	34.1%	43.9%	52.2%	41.4%
% of total	15.9%	12.8%	12.7%	41.4%
Acute respiratory distress syndrome
Count	18	6	8	32
% within transfusion threshold	6.9%	3.7%	5.9%	5.7%
% of total	3.2%	1.1%	1.4%	5.7%
Pulmonary edema
Count	20	12	7	39
% within transfusion threshold	7.7%	7.3%	5.1%	7.0%
% of total	3.6%	2.1%	1.2%	7.0%
Myocardial infarction
Count	33	25	23	81
% within transfusion threshold	12.6%	15.2%	16.9%	14.4%
% of total	5.9%	4.5%	4.1%	14.4%

↓ Table 2. Comorbidities and Complications of the Study Population

Transfusion threshold

Hb < 7 (n = 261)

Hb 7–8 (n = 164)

Hb > 8 (n = 135)

Total (n = 560)

Hb: hemoglobin; COPD: chronic obstructive pulmonary disease.

Comorbidities

Cardiovascular disease

Count

% within transfusion threshold

12.3%

14.6%

19.1%

14.6%

% of total

5.7%

4.3%

4.6%

14.6%

Peripheral vascular disease

Count

% within transfusion threshold

6.5%

8.5%

6.6%

7.1%

% of total

3.0%

2.5%

1.6%

7.1%

COPD

Count

196

% within transfusion threshold

33.7%

36.6%

35.3%

34.9%

% of total

15.7%

10.7%

8.6%

34.9%

Chronic kidney disease

Count

186

% within transfusion threshold

34.1%

30.1%

33.2%

% of total

15.9%

10.0%

7.3%

33.2%

Diabetes

Count

181

% within transfusion threshold

36.4%

27.4%

30.1%

32.3%

% of total

16.9%

8.0%

7.3%

32.3%

Complications

Sepsis

Count

133

243

% within transfusion threshold

51.0%

36.0%

37.5%

43.3%

% of total

23.7%

10.5%

9.1%

43.3%

Acute kidney injury

Count

130

268

% within transfusion threshold

49.8%

44.5%

47.8%

% of total

23.2%

13.0%

11.6%

47.8%

Respiratory failure

Count

156

298

% within transfusion threshold

59.8%

45.1%

50.0%

53.1%

% of total

27.8%

13.2%

12.1%

53.1%

Cardiac arrest

Count

% within transfusion threshold

6.9%

5.5%

11.0%

7.5%

% of total

3.2%

1.6%

2.7%

7.5%

Heart failure

Count

199

% within transfusion threshold

36.8%

32.9%

36.0%

35.5%

% of total

17.1%

9.6%

8.7%

35.5%

Altered mental state

Count

% within transfusion threshold

11.9%

4.9%

8.1%

8.9%

% of total

5.5%

1.4%

2.0%

8.9%

Mechanical ventilator requirement

Count

232

% within transfusion threshold

34.1%

43.9%

52.2%

41.4%

% of total

15.9%

12.8%

12.7%

41.4%

Acute respiratory distress syndrome

Count

% within transfusion threshold

6.9%

3.7%

5.9%

5.7%

% of total

3.2%

1.1%

1.4%

5.7%

Pulmonary edema

Count

% within transfusion threshold

7.7%

7.3%

5.1%

7.0%

% of total

3.6%

2.1%

1.2%

7.0%

Myocardial infarction

Count

% within transfusion threshold

12.6%

15.2%

16.9%

14.4%

% of total

5.9%

4.5%

4.1%

14.4%

↓ **Table 3.** Transfusion Burden and Mortality Rate of the ICU Patients
	Hb < 7 (n = 261)	Hb 7–8 (n = 164)	Hb > 8 (n = 135)	Total (n = 560)
ICU: intensive care; Hb: hemoglobin.
Multiple transfusions
Count	199	93	93	385
% within transfusion threshold	76.2%	56.7%	68.4%	68.6%
% of total	35.5%	16.6%	16.6%	68.6%
Transfusion complications
Count	1	0	0	1
% within transfusion threshold	0.4%	0.0%	0.0%	0.2%
% of total	0.2%	0.0%	0.0%	0.2%
Mortality
Count	52	21	35	108
% within transfusion threshold	19.9%	12.8%	25.7%	19.3%
% of total	9.3%	3.7%	6.2%	19.3%

↓ Table 3. Transfusion Burden and Mortality Rate of the ICU Patients

Hb < 7 (n = 261)

Hb 7–8 (n = 164)

Hb > 8 (n = 135)

Total (n = 560)

ICU: intensive care; Hb: hemoglobin.

Multiple transfusions

Count

199

385

% within transfusion threshold

76.2%

56.7%

68.4%

68.6%

% of total

35.5%

16.6%

68.6%

Transfusion complications

Count

% within transfusion threshold

0.4%

0.0%

0.2%

% of total

0.2%

0.0%

0.2%

Mortality

Count

108

% within transfusion threshold

19.9%

12.8%

25.7%

19.3%

% of total

9.3%

3.7%

6.2%

19.3%

↓ **Table 4.** Multivariate Analysis of Mortality
	Adjusted odds	95% CI	Wald	df	Significance
CI: confidence interval.
Hemoglobin < 7	Reference			8.138	2	0.017
Hemoglobin 7–8	0.783	0.430	1.427	0.637	1	0.425
Hemoglobin > 8	1.893	1.093	3.281	5.180	1	0.023
Age	1.019	0.998	1.040	3.204	1	0.073
Sepsis	2.185	1.341	3.563	9.834	1	0.002
Respiratory failure	5.063	2.746	9.335	27.006	1	< 0.001
Ventilator days	1.048	1.015	1.082	8.359	1	0.004
Constant	0.012			33.090	1	< 0.001

↓ Table 4. Multivariate Analysis of Mortality

Adjusted odds

95% CI

Wald

Significance

Lower

Upper

CI: confidence interval.

Hemoglobin < 7

Reference

8.138

0.017

Hemoglobin 7–8

0.783

0.430

1.427

0.637

0.425

Hemoglobin > 8

1.893

1.093

3.281

5.180

0.023

Age

1.019

0.998

1.040

3.204

0.073

Sepsis

2.185

1.341

3.563

9.834

0.002

Respiratory failure

5.063

2.746

9.335

27.006

< 0.001

Ventilator days

1.048

1.015

1.082

8.359

0.004

Constant

0.012

33.090

< 0.001

↓ **Table 5.** Readmission Rates of the ICU Patients
	Transfusion threshold
Based on a crosstabulation test, it can be concluded that there is an association between readmission rates and the threshold levels (Chi-square = 13.105, df = 6, P ≤ 0.041). ICU: intensive care; Hb: hemoglobin.
No readmission
Count	180	136	103	419
% within transfusion threshold	69	82.9	76.3	74.8
Standardized residual	–1.1	1.2	0.2
30-day readmission
Count	61	18	22	101
% within transfusion threshold	23.4	11	16.3	18
Standardized residual	2	–2.1	–0.5
60-day readmission
Count	12	8	7	27
% within transfusion threshold	4.6	4.9	5.2	4.8
Standardized residual	–0.2	0	0.2
90-day readmission
Count	8	2	3	13
% within transfusion threshold	3.1	1.2	2.2	2.3
Standardized residual	0.8	–0.9	–0.1

↓ Table 5. Readmission Rates of the ICU Patients

Transfusion threshold

Hb < 7 (n = 261)

Hb 7–8 (n = 164)

Hb > 8 (n = 135)

Total (n = 560)

Based on a crosstabulation test, it can be concluded that there is an association between readmission rates and the threshold levels (Chi-square = 13.105, df = 6, P ≤ 0.041). ICU: intensive care; Hb: hemoglobin.

No readmission

Count

180

136

103

419

% within transfusion threshold

82.9

76.3

74.8

Standardized residual

–1.1

1.2

0.2

30-day readmission

Count

101

% within transfusion threshold

23.4

16.3

Standardized residual

–2.1

–0.5

60-day readmission

Count

% within transfusion threshold

4.6

4.9

5.2

4.8

Standardized residual

–0.2

0.2

90-day readmission

Count

% within transfusion threshold

3.1

1.2

2.2

2.3

Standardized residual

0.8

–0.9

–0.1