Blood transfusion practice in the UK and Ireland: a survey of palliative care physicians

Restrictive Blood Transfusion Policy for the Management of Anemia in Palliative Care in Finland

Objectives

Restrictive blood transfusion policy has been shown to be effective in managing anemia. However, treatment of anemia in palliative (PC) and end-of-life (EOL) care remains understudied. The aim of this study was to examine Finnish PC physicians' attitudes and practices in the management of anemia.

Methods

A structured questionnaire asking clinicians about how they treat anemia in PC was developed with a focus on blood transfusion. In addition, a previously published collection of clinical case scenarios was included. Physician's recall of their use of red blood cell (RBC) transfusions in 2021 was also asked. The questionnaire was first delivered at an annual meeting of the Finnish Association for Palliative Medicine in 2022 and subsequently, a Webpropol form was emailed to the members of the society.

Results

A total of 94 (28%) doctors at an average age of 46.5 years responded. Of these 80% were specialists and 75% had a special competence in palliative medicine. RBC transfusions were given in less than 25% of patients, average hemoglobin was b ≤ 78 g/L. Transfusions were given for clinical symptoms such as fatigue, angina, and weakness without systematic measurement of symptom severity. Hematinic levels were investigated, but iron was given seldom. Clinical scenarios were answered similarly as previously in the UK. National guidelines for anemia in early PC or EOL care are lacking but would be deemed to be helpful by one-third of those who completed the questionnaire.

Conclusion

Physicians apply the restrictive policy in blood transfusions for PC patients in Finland. Other treatments for anemia are not often used. Both prospective studies and national guidelines are needed.

Red cell transfusion benefits in oncology, haematology and palliative medicine populations: a narrative review

Due to the heterogenous nature of the palliative medicine patient population, assessment of benefit, and thus choice of appropriate patient for consideration of transfusion, can be challenging. This can be confounded by the use of both liberal and restrictive transfusion thresholds. The multifactorial nature of many symptoms of anaemia, particularly in patients with advanced malignancy, can further complicate. As such, there is a paucity of data supporting the subjective, objective and clinical benefit of red cell transfusion in the palliative medicine setting. This narrative review summarises the research and evidence surrounding the benefits of red cell transfusion, with a particular emphasis on the oncological, haematological and palliative medicine population. There is a lack of a validated, reproducible patient-reported outcome measures (PROM) to assess response to red cell transfusions in the palliative medicine population with outcome measures varying from objective improvement in haemoglobin level post-transfusion, to subjective response in primary symptom(s). Further investigation is required regarding the development of effective PROMs assessing response to red cell transfusion in the palliative medicine population, to ensure judicious use of this scarce and valuable resource.