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Letter to Editor: An observational study of red cell transfusion in specialist palliative care

Dear Sir – We wish to report our findings of an observational study of red cell transfusion practice in specialist palliative care. This was conducted in two specialist palliative care inpatient units in the United Kingdom. The combined catchment population was one million and, in the period analysed, there were 944 admissions. One hundred transfusion episodes occurred and 73 individual patients received transfusions. Fifty-four (73.9%) patients received a single transfusion with the remaining 19 (26.1%) receiving multiple transfusions. Thirty-five (47.9%) patients were male and the mean age was 66.5 years (range 37–102 years, SD 13.56). Seventytwo (98.6%) patients had a malignant diagnosis. Prostate cancer was the most common primary tumour and occurred in 19 (26.3%) patients. There was a high proportion of patients with gastrointestinal cancer and lung cancer; 13 (17.8%) and 11 (15.1%) respectively. The most common site of metastases was bone, present in 32 (44%) patients. Low haemoglobin (Hb) level was documented as a trigger, either solely or in conjunction with other reasons, in 73 (73%) transfusions. Anaemia was deemed the only reason for transfusion in 26 (26%) cases. Haematinics (B12, folate, ferritin or combination) were checked in nine (9%) transfusions. The mean pre-transfusion Hb was 7.9 g/dL (range 4.3–11.4, SD 0.95) and mean post-transfusion Hb was 10.0 g/dL (range 7.2–13.0, SD 1.29). The mean number of units transfused was 2.2 (range 2–4 units). A response to transfusion was recorded in 38 (38%) transfusion episodes with 31 (31%) having a positive response. The transfusion decision was not documented as being discussed with either patients and/or relatives in the majority of cases (78%). The mean number of days between the last transfusion and death was 47 days (range 2–293 days, SD 57.1). Ten (13.7%) patients died within seven days of transfusion.