Background Red blood cell transfusion has historically been used to treat the symptoms of anaemia in palliative care. However it has been demonstrated that investigation of anaemia and alternative treatments may improve symptoms without the risk of transfusion associated complications.¹

Aims To evaluate blood transfusion practice in Marie Curie Hospice Bradford and compare this to National Institute for Health and Care Excellence Guidelines,² and Recommendations for Palliative Care Practice from a National Comparative Audit in red blood cell transfusion.¹

Method A retrospective analysis of electronic notes for the period 2018–2020 was undertaken to identify all patients referred for red cell transfusion. Notes were reviewed in detail to establish the clinical information around each transfusion.

Results Out of a total of 38 patients referred for consideration of transfusion, 35 (92%) went on to receive red cells. Only 47% of patients had haematinics checked prior to transfusion. 74% of patients received 2 units of blood in one treatment episode but only 14% had their weight assessed. A TACO risk assessment was documented in 66%. Discussions with the medical team identified that patients referred to the service had the expectation of receiving a blood transfusion prior to the completion of a medical assessment at the hospice, and that these expectations impacted upon the decision to offer transfusion.

Conclusions An ‘Anaemia Assessment Clinic’ was developed. An electronic template now prompts clinicians to ensure patients have haematinics investigated and managed, a weight recorded and a discussion about the evidence based risks and benefits of transfusion. Guidance was written for both the outpatient and inpatient settings to ensure a restrictive transfusion threshold is used and to reduce the risks of transfusion associated circulatory overload.

References

1. Neoh K, Gray R, Grant-Casey J, Estcourt L, Malia C, Boland JW, Bennett MI. National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice. Palliat Med. 2019 Jan;33(1):102–108

2. National Institute for Health and Care Excellence (NICE). NICE guidelines [NG24] blood transfusion, http://www.nice.org.uk/guidance/ng24/chapter (2015, accessed May 2022).