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Blood transfusions: time for a change in practice?
  1. Elizabeth Brown
  1. Saint Michaels Hospice, Harrogate HG2 8QL, UK
  1. Correspondence to Dr Elizabeth Brown, Saint Michaels Hospice, Harrogate HG2 8QL, UK; lbrown{at}saintmichaelshospice.org

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For an issue that has such high incidence and clinical relevance, anaemia management remains under-researched in palliative care. We look at other medical research and guidelines such as the National Institute for Health and Care Excellence (NICE) guidelines for transfusion, which may have little relevance to our patient population.

The study by Neoh et al in this month’s issue highlights the void.1 Four common management scenario vignettes sent to UK and Ireland palliative care physicians reveal that most (52% to 84%, depending on the scenario) do not follow NICE guidelines of a threshold for red blood cell (RBC) transfusion of 70 g/L in stable patients with no major haemorrhage.2 Physicians apply a more liberal approach, transfuse at higher thresholds and, once decided to transfuse, give multiple units rather than the one (with reassessment) advocated by NICE. Divergence was more marked in senior physicians, which has important sequelae as they are more likely to direct overall management. Neoh et al suggest that this may be due to training grade doctors’ awareness of current guidelines and the restrictive transfusion approach advocated in UK acute hospital settings. So, is it time to teach old dogs new tricks or are there reasons for the divergence?

The 2015 guideline’s key priorities for implementation include:

  1. Haemoglobin concentration threshold of 7 g/dL.

  2. Single units for adults without active bleeding.

  3. Target of 7–9 g/dL after trans­fusion.

To set a threshold, NICE reviewed 34 studies (mainly in gastrointestinal bleeding, intensive care, surgery and trauma). A threshold of 7 g/dL was (unsurprisingly) associated with the use of less RBC and fewer transfusion-related adverse events, with no …

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