Whilst there is compelling evidence to support use of blood in children with profound anaemia and severe anaemia with respiratory distress[2,3] evidence supporting transfusion avoidance in the group with severe anaemia (Hb 4–5 g/dL) without respiratory distress or moderately severe anaemia (Hb < 7 g/dl) with life-threatening complications [2,21,22] is less convincing. The gene discussed is GSTM1; the disease is anemia (phenotype).