• To Timothy H M THM 1 Palliative and Supportive Services, Flinders University , Adelaide, Australia . 2 S, Thomas W LeBlanc, Peter Eastman, Karen Neoh, Meera R Agar, Luen Bik To, Debra Rowett, Zac Vandersman, and David C Currow.
• 1 Palliative and Supportive Services, Flinders University , Adelaide, Australia .
• J Palliat Med. 2017 Oct 1; 20 (10): 1152-1157.

BackgroundRed Blood Cell (RBC) transfusions are commonly used in palliative care. RBCs are a finite resource, transfusions carry risks, and the net effect (benefits and harms) is poorly defined for people with life-limiting illnesses.ObjectiveTo examine the indications and effects of RBC transfusion in palliative care patients.DesignThis international, multisite, prospective consecutive cohort study.Setting/SubjectsPalliative care patients undergoing RBC transfusion.MeasurementsTarget symptoms (fatigue, breathlessness, generalized weakness, or dizziness) were assessed before transfusion and at day 7 by treating clinicians, using National Cancer Center Institute Common Terminology Criteria for Adverse Events. Assessment of harms was made at day 2.ResultsOne hundred and one transfusions with day 7 follow-up were collected. Median age was 72.0 (interquartile range 61.5-83.0) years, 58% men, and mean Australia-modified Karnofsky Performance Status (AKPS) of 48 (standard deviation [SD] 17). A mean 2.1 (SD 0.6) unit was tranfused. The target symptoms were fatigue (61%), breathlessness (16%), generalized weakness (12%), dizziness (6%), or other (5%). Forty-nine percent of transfusions improved the primary target symptom, and 78% of transfusions improved at least one of the target symptoms. Harms were infrequent and mild. An AKPS of 40%-50% was associated with higher chances of symptomatic benefit in the target symptom; however, no other predictors of response were identified.ConclusionsIn the largest prospective consecutive case series to date, clinicians generally reported benefit, with minimal harms. Ongoing work is required to define the optimal patient- and clinician-reported hematological and functional outcome measures to optimize the use of donor blood and to minimize transfusion-associated risk.

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