Anemia at the end of life: prevalence, significance, and causes in patients receiving palliative care

Abstract

While data exist on the prevalence and causes of anemia in defined groups of the elderly, information on palliative care patients is limited. Compared to actively treated oncology patients, for whom anemia treatment has demonstrated improved quality of life and symptom alleviation, studies of treatment outcomes in palliative care patients are limited. Knowledge of the extent and causes of anemia in palliative care patients is needed, as correction of anemia in these patients could potentially improve their physical, emotional, and cognitive functioning. In the present study, clinical data and blood test results of 105 patients meeting specific eligibility criteria were examined to estimate the prevalence of anemia and investigate its causes. Ninety-five (90.5%) patients had advanced cancer. Based on World Health Organization criteria, anemia was found in 77% of men (Hb <130 g/l) and 68.2% of women (Hb <120 g/l). The diagnosis was anemia of chronic disease in 76.7% of women and 46.8% of men. Patients with prostate cancer had a significantly lower mean Hb level (P=0.007) and more evidence of bone metastases (P=0.0007) than those with other cancers. Neutrophil hypersegmentation, suggesting occult folate deficiency, was present in 28.6% of patients, being more common in those with major weight loss (58.3%) than those with moderate (37%) or mild/no weight loss (26%) (P=0.019). The findings suggest that anemia is highly prevalent in the palliative care setting. Although anemia of chronic disease is most common, occult folate deficiency may be more prevalent than previously suspected. The findings suggest that a low serum folate level is an insensitive marker of occult folate deficiency. A randomized controlled trial of folic acid treatment is proposed.

The Prospective Evaluation of the Net Effect of Red Blood Cell Transfusions in Routine Provision of Palliative Care

“…8 By contrast, another study of anaemic palliative care patients found occult folate and B12 deficiency in nearly 30% and 7% respectively. 4 Could the use of erythropoietin for those with renal dysfunction, or iron supplementation for those with absolute or functional iron deficiency, ameliorate the need for transfusions in some sub-groups?…”

“…[1][2][3][4][5] Causes include chronic inflammation, erythropoietin deficiency, bone marrow infiltration, bleeding, haematinic depletion and treatment effects.…”

Use of Blood Transfusion at the End of Life: Does it Have Any Effects on Survival of Cancer Patients?

“…In the Cochrane review 31% and 70% of participants appeared to show some symptomatic response to blood transfusion between day two to seven, with scores (where measured) returning to near baseline levels by day 14. On the other hand Dunn et al (2003) did not find a significant association between anemia and presence of fatigue (Dunn et al, 2003). Monti had reported that transfusions administered during the last 4 weeks of life were likely to prove a useless procedure that does not influence the quality of life (Monti et al, 1996).…”

Estimating prevalence of functional iron deficiency anaemia in advanced cancer

“…However, in patients with advanced cancer, fewer data are available. In a study of 105 palliative care patients, the majority of which had cancer, 77% of men and 68.2% of women were anaemic [4]. Aetiology of anaemia in advanced cancer has not been well described.…”

“…A large study of 1528 patients with stage I-IV cancer found FID to comprise 81.9% of those with any sign of iron deficiency combined with haemoglobin ≤120g/l [2]. In another study that included 76 (72.3%) patients with metastatic cancer in the palliative care setting, FID was diagnosed in 76.7% of anaemic women and 46.8% of anaemic men [4]. In that study, FID was defined as low iron stores and low iron binding capacity in those with a haemoglobin ≤120g/l.…”