Background In a palliative care setting, to whom should we offer blood transfusion and when should we stop? Is there consensus regarding the best care for our patients? Transfusion should be based on an assessment of symptom management and patient wish. The British Committee for Standards in Haematology (BCSH) guidelines' acknowledge complexity and suggest the decision to transfuse is largely based on the clinical situation. Gleeson (1995) demonstrated that cancer patients showed a significant improvement in strength and well-being with blood transfusion (pretransfusion Hb ranging from 4.9–10.7 g/dl). No previously published audit has looked at regional practice among both haematologists and palliative care physicians.
Aims To provide a snapshot of blood transfusion practice in the palliative care setting within the Northern Region (UK). Is current practice in keeping with guidelines?
Methods An anonymised questionnaire was sent to regional haematology (N=33) and palliative care (N=55) physicians. The questionnaire was based on a fictional scenario involving a lady with metastatic breast cancer and symptoms of anaemia (fatigue and dyspnoea). The respondents were asked to indicate whether transfusion would be offered in differing clinical circumstances.
Results 98% of respondents offered transfusion if the symptomatic patient had a Hb of 8 g/dl. 73% offered transfusion with an Hb of 10.5 g/dl. 3% would offer transfusion with an Hb of 8 g/dl, but no symptomatic benefit with previous transfusions. There was general consensus between palliative care and haematology for these decisions. 42% would transfuse a patient with a prognosis of days to weeks, an Hb of 8 g/dl and previous symptomatic improvement with blood transfusion. A greater proportion of haematologists would transfuse in this circumstance.
Conclusion There is general consensus to use blood transfusion for symptom control in a palliative care setting. Differing opinion arises when progonosis is shorter. Current practice is in keeping with BCSH guidelines.
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