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Grand RoundsWeekly Evidence Brief

Hematology

Edition

30-Second Takeaway

  • Transfusion thresholds for AMI with anemia appear **sex-neutral**.
  • Low-level FLT3-ITD microclones associate with higher relapse risk in intensive-therapy AML.
  • Peri-transplant fluid overload consistently links to higher non-relapse mortality.

Week ending May 23, 2026

Selected recent hematology evidence briefs for clinicians

Sex does not modify transfusion strategy effect in AMI with anemia (MINT secondary analysis).

CIRCULATIONMay 18, 2026

In 3,504 MINT participants with AMI and anemia, outcomes were similar between restrictive and liberal transfusion arms across sexes. Primary 30‑day death or MI occurred in 15.4% of women and 15.4% of men overall. Women had lower 180‑day mortality (11.0% vs 13.5%), but there was no significant sex-by-treatment interaction for the primary outcome. Authors conclude transfusion thresholds used in MINT can be applied without sex-specific modification.

Extreme CBC values and large increases in red-cell indices link to obstetric complications.

PLOS MEDICINEMay 20, 2026

Researchers derived gestational-age reference intervals from ~46,000 pregnancies and validated associations in ~49,000 additional pregnancies. Hematocrit, hemoglobin, and red cell count above gestational references were associated with higher composite obstetric risk (ORs ≈ 1.4–1.6). Large increases in hemoglobin (>0.67 g/dL) or red cell count between early and mid-pregnancy associated with higher preterm birth risk (ORs ≈ 1.9–2.1). Findings apply to pregnancies with early prenatal care; retrospective design and excluded early deliveries limit inference.

FLT3-ITD microclones predict higher relapse after intensive chemotherapy in young AML adults.

BLOODMay 21, 2026

Post-hoc BIG-1 analysis of 1,733 patients found FLT3-ITD microclones (AR 0.0004–0.05) in 17.4% of cases without macroclones. At 2 years, relapse incidence was 45.1% with microclones, 42.5% with macroclones, and 29.4% without FLT3-ITD. Microclones and macroclones independently increased relapse risk after multivariable adjustment. This post-hoc result suggests integrating sensitive NGS FLT3-ITD detection into prognostic workflows, pending prospective validation.

References

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Additional Reads

Optional additional studies from this edition.

Edition context

Clinical signal

  • Use the same restrictive/liberal transfusion thresholds for women and men with AMI and anemia.
  • Consider NGS FLT3-ITD testing sensitivity when assessing relapse risk; prospective management guidance pending.
  • Monitor and minimize fluid accumulation around allo-HSCT; standardize definitions locally.