Do blood transfusions make a difference when you are dying?

Abstract

Recent blood transfusion guidelines published by the UK National Institute for Health and Care Excellence (2015) recommend restrictive single unit transfusion practices with a threshold haemoglobin level of 70 g/l. While these guidelines do not specifically relate to palliative care patients, neither do they exclude them. Prompted by these guidelines, and studies questioning the costs and benefits of red cell transfusions, a retrospective review of the electronic patient records was undertaken to explore the use and impact of blood transfusions over a 54-month period on the in-patient unit of a 14-bedded hospice in the UK. The objective was to identify the reasons for transfusion and documented evidence of benefit and outcome. Results showed that transfusions were infrequent, the reason given for transfusion was fatigue in 84% of cases, benefit was reported in 39%, and 50% died within 4 weeks of transfusion. These findings are similar to those of other studies highlighting the low level of benefit and short survival time post-transfusion. Anaemia is common in the palliative population and fatigue is increasingly prevalent in the final weeks of life. It has been postulated that fatigue may provide protection from suffering at this time, suggesting that appropriate selection of patients for transfusion is important to prevent the potential to do harm. The use of validated tools, goal setting conversations, and an algorithm for the management of fatigue have now been implemented to support more rational transfusion decisions in the hospice.