Transfusion of Blood Products in Palliative Care

Transfusion of blood products in patients with advanced and life threatening disease can be a lead to difficult ethical and clinical situations.
There are perhaps two basic scenarios encountered:

1. A new situation that has arisen which giving a transfusion may alleviate to some extent (for instance, bleeding from a tumor which has caused the patient to become anemic and have symptoms of fatigue and breathlessness)

2. An ongoing disease process in which transfusion of blood products has been part of normal supportive care. As the disease progresses the question arises whether these should be continued (for instance, with a child with relapsed leukemia for whom there is no further curative therapy)

In both situations within the context of patient’s wishes and prognosis there should be balance between the benefits of transfusion and the burdens and possible harm (see comments regarding Balanced Care in Foreword).

At all times the patient and family/caregivers should be part of the process of deciding whether a transfusion should take place or regular transfusions should be ceased

Red Blood Cells

  • If the patient is found to be anemic transfusion may help symptoms of weakness, fatigue, breathlessness and headache. If the life expectancy of the patient allows, a trial of transfusion of red cells may be warranted. If the patient continues to be anemic further transfusions may be warranted
  • If the patient deteriorates then continued transfusion may become futile or increasingly burdensome
  • Adverse effects such as fluid overload and transfusion reactions should be monitored in the usual manner

Platelet Transfusion

It should be remembered that transfused platelets remain viable for around 2 days

May be considered if spontaneous bleeding is occurring

  • And is distressing
  • And if patient’s prognosis makes the transfusion worthwhile

Or may be considered to prevent possible bleeding

  • If there is a specific reason to prevent spontaneous bleeding (i.e. during travel)

Fresh Frozen Plasma

May be considered in special circumstances in palliative care when coagulation affected by:

  • Warfarin overdose
  • Liver disease
  • DIC

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