A Retrospective Chart Review of Transfusion Practices in the Palliative Care Unit Setting

Abstract

Background: There remains limited data in the literature on the frequency, clinical utility and effectiveness of transfusions in palliative care, with no randomized controlled trials or clinical practice guidelines on this topic. There are no routinely accepted practices in place for the appropriate transfusion of blood products in this setting. Aim: The aim of this study was to retrospectively review all transfusions in the palliative care units of 2, tertiary care hospitals in Canada. The goals were to elucidate the frequency, indications, patient characteristics, and practices around this intervention. Design: Descriptive, retrospective chart review. Setting/Participants: The clinical charts of patients admitted to the palliative care unit and who obtained blood transfusions for the period of April 1, 2015, to March 31, 2017, were reviewed. All patients admitted who obtained a transfusion were included. There were no exclusion criteria. Results: Transfusions in the palliative care units were rare despite their availability (0.9% at Sunnybrook and 1.4% Baycrest) and were primarily given to patients with cancer. The main symptom issues identified for transfusion were fatigue and dyspnea. The majority of patients endorsed symptomatic benefit with minimal adverse reactions though pre-and post-transfusion assessment practices varied greatly between institutions. Conclusions: Transfusions in the palliative care units were infrequent, symptom targeted, and well tolerated, though the lack of standardized pre/post assessment tools limits any ability to draw conclusions about utility. Patients would benefit from additional research in this area and the development of clinical practice guidelines for transfusions in palliative care.

Transfusion Practices In Advanced Cancer Patients

“…Neoh et al [11] report that 70% of patients had an Hb above the trigger threshold of 7.0 g/dL, while we found an inferior frequency of 42%. Also, we found a median of RBC units given per TE (1.0) similar to Sirianni et al [15] and lower than Neoh et al [11] (2.0) and Timothy et al retrospective [10] (2.3) and prospective [3] (2.1) studies. These results may re ect doctors' effort to adopt a restrictive blood transfusion strategy in a PC setting.…”

“…We found a mean pretransfusion Hb level of 6.85 g/dL, lower than Neoh et al [11] (7.5 g/dL) and Timothy et al retrospective [10] (7.8 g/dL) and prospective [3] (7.2 g/dL) studies but higher than Sirianni et al [15] (6,5 g/dL). Neoh et al [11] report that 70% of patients had an Hb above the trigger threshold of 7.0 g/dL, while we found an inferior frequency of 42%.…”

“…It is likely that a higher number of patients had symptoms, but they were not registered in patient les. Similarly, to other studies [3,10,15] the most reported symptom was asthenia/fatigue.…”

Platelet transfusions in haematologic malignancies in the last six months of life

“…Those previous studies showed a great variability in the platelet transfusion burden at the end‐of‐life. Whereas no platelet units were issued per patient in a palliative care unit [8], a median of 11·57 was issued in intensive care units or haematology departments [9]. This variability also concerned the symptom burden, ranging from zero in a palliative care unit [8] to 60% (with 20% of grade 4) in intensive care units or haematology departments [9].…”

“…Whereas no platelet units were issued per patient in a palliative care unit [8], a median of 11·57 was issued in intensive care units or haematology departments [9]. This variability also concerned the symptom burden, ranging from zero in a palliative care unit [8] to 60% (with 20% of grade 4) in intensive care units or haematology departments [9]. Prophylactic transfusions, which are valid [10] although debated [4, 5, 11], were almost regular practice [12].…”