Background Severe anaemia is common in the hospice setting. Causes include anaemia of chronic disease (ACD) and associated functional iron deficiency (FID), with or without absolute iron deficiency anaemia (IDA). National guidance advises anaemia is investigated and treated to reduce need for blood transfusion.1 However, this is infrequently done.2 Blood transfusion is used to treat symptomatic anaemia but there is limited evidence on effectiveness and duration of response.3,4 Harm of transfusion is well documented; even a single unit risks transfusion associated circulatory overload (TACO).5 Consequently, guidelines were introduced to an inpatient palliative care unit to ensure anaemia was investigated, IV iron prescribed appropriately, and a restrictive transfusion strategy based on weight adopted.
Method Retrospective data collection from patients admitted for blood transfusion over one year: investigations (iron studies, haematinics, CRP); IV iron prescriptions. Risk factors for TACO were collated.
Results 37 units were administered to 15 patients. 58% had one unit; the remaining had two. Mean pre-transfusion haemoglobin 67g/L (44g/L–84g/L). Mean post-transfusion haemoglobin 78g/L (43g/L-125g/L); checked in 54% patients. 50% patients had <5g/L improvement in haemoglobin. Iron studies and haematinics were requested in 73% patients; at least one requested in 92%. IDA was identified in one patient, FID identified in four, and a combination IDA/FID in two. Five had no deficiency. Of the seven with IDA or FID, five received blood and iron infusions. 100% patients had one risk factor for TACO; 47% had two and 27% had three. 50% had a weight recorded within 2 months of transfusion.
Conclusion Guideline introduction increased investigation into causes of anaemia. Identification of FID/IDA enabled treatment with IV iron and blood transfusion. Prior to guideline introduction, IV iron had not been prescribed. High risk of TACO mandates a cautious approach to blood transfusion and supports a restrictive transfusion strategy.
NICE (2015) Blood transfusion. National Guideline NG24. www.nice.org.uk
Neoh K, et al. (2019) National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice. Palliative Medicine.33:1021â€’08.
Uceda Torres ME, et al. (2014) Transfusion in palliative cancer patients: A review of the literature. Journal of Palliative Medicine.17: 88â€’104.
Chin-Yee N, et al. (2018) Red blood cell transfusion in adult palliative care: a systematic review. Transfusion. 58: 233â€’241.
SHOT. Annual SHOT Report 2019. https://www.shotuk.org/resources/current-resources (accessed 20th December 2020).Save
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