Blood transfusions in palliative care: a method to improve quality of life or a double-edged sword? A mini-review
Abstract
Blood transfusions are uncommon in the palliative care setting. There are no guidelines to make decisions about blood transfusions in palliative care. Certainly, these decisions cannot be made basing on the hemoglobin level only. Occasionally the issue of blood transfusion is being discussed with the family. Instead of being a bridge to recovery and self-sufficiency of the bone marrow, like non-palliative medicine, blood transfusions are appreciated as buying some quality time for the patient. However, this issue is questionable in the light of available data and experience. Blood transfusion can boost the patient’s energy for days or a week, but it can also have more adverse effects including re-bleeding and unexplained death. Controlled data on this subject are absent. In the discussions on blood transfusions with the patients and their families these aspects should not be forgotten. Blood transfusions remain, not without reason a rare but possible procedure in palliative care.
Keywords: blood transfusionpalliative caresymptoms
References
- Chin-Yee N, Taylor J, Rourke K, et al. Red blood cell transfusion in adult palliative care: a systematic review. Transfusion. 2018; 58(1): 233–241.
- Dunn A, Carter J, Carter H. Anemia at the end of life: prevalence, significance, and causes in patients receiving palliative care. J Pain Symptom Manage. 2003; 26(6): 1132–1139.
- Monti M, Castellani L, Berlusconi A, et al. Use of red blood cell transfusions in terminally ill cancer patients admitted to a palliative care unit. J Pain Symptom Manage. 1996; 12(1): 18–22.
- National Clinical Guideline Centre (UK). Blood Transfusion. 2015 Nov; London: National Institute for Health and Care Excellence (NICE).
- Carson JL, Guyatt G, Heddle NM, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA. 2016; 316(19): 2025–2035.
- Wytyczne w zakresie leczenia krwią i jej składnikami oraz produktami krwiopochodnymi w podmiotach leczniczych, Narodowe Centrum Krwi, 2020.
- Neoh K, Gray R, Grant-Casey J, et al. National comparative audit of red blood cell transfusion practice in hospices: recommendations for palliative care practice. Palliat Med. 2019; 33(1): 102–108.
- Neoh K, Stanworth S, Bennett MI. Blood transfusion practice in the UK and Ireland: a survey of palliative care physicians. BMJ Support Palliat Care. 2019; 9(4): 474–477.
- Brown E, Bennett M. Survey of blood transfusion practice for palliative care patients in Yorkshire: implications for clinical care. J Palliat Med. 2007; 10(4): 919–922.
- Raval JS. Transfusion as a palliative strategy. Curr Oncol Rep. 2019; 21(10): 92.
- Prommer E. Management of bleeding in the terminally ill patient. Hematology. 2005; 10(3): 167–175.
- Bętkowska IA, Zylicz Z. Stany nagłe w opiece paliatywnej — praktyka kliniczna poparta faktami. Med Paliat Prakt. 2017; 11(4): 153–165.
- Subramaniam K, Spilsbury K, Ayonrinde OT, et al. Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding. Transfusion. 2016; 56(4): 816–826.
- Li K, Xu Y. Citrate metabolism in blood transfusions and its relationship due to metabolic alkalosis and respiratory acidosis. Int J Clin Exp Med. 2015; 8(4): 6578–6584.
- Goksu SS, Gunduz S, Unal D, et al. Use of blood transfusion at the end of life: does it have any effects on survival of cancer patients? Asian Pac J Cancer Prev. 2014; 15(10): 4251–4254.
