Does packed red cell transfusion provide symptomatic benefits to cancer palliative patients?: a longitudinal study from a single private oncology center in Nepal

Abstract

Background Palliative patients generally present with symptoms of dyspnea, easy fatigability, lethargy and feeling of being unwell which can broadly be attributed to one root cause: cancer-related anemia. So, packed red cell transfusion is often carried out aiming to improve patients’ functional status. Different cut off hemoglobin values have been suggested, with Hb < 9 g/dL the most commonly accepted. The present study aims at evaluating and comparing the benefits in subjective symptoms of fatigue and breathlessness among transfused and non-transfused palliative patients on Day 0 and Day 7. Methods Hemoglobin values, anemia related subjective symptoms of fatigue and breathlessness were recorded from 122 patients. The patients were re-evaluated on day-7 post-transfusion. The pre and post-transfusion symptomatic benefit was compared in both transfused and non-transfused palliative care patients. Results The currently practiced hemoglobin trigger for packed red cell transfusion is 10 g/dL. The units of packed red cell to be transfused was decided according to the hemoglobin values targeting the rise to > 10 g/dL. A mean 1.36 units were transfused. Statistically significant improvement was observed in patient reported symptoms of fatigue and breathlessness among both transfused and non-transfused palliative patients. Conclusion Anemic cancer palliative patients were found to benefit following packed red cell transfusion, suggesting a favorable association between the transfusion and patient-reported fatigue and dyspnea.

Supportive care and symptom management in patients with advanced hematological malignancies: a literature review

“…Red blood cell transfusion helps improve symptoms and the deleterious effects on different organ systems. Recent literatures showed favorable associations between the transfusion and patient-reported symptoms (9,10). For haemodynamically stable, asymptomatic patients, a restrictive strategy with a Hb trigger at 7 g/dL is recommended.…”

End-of-life transfusions in patients with an oncological diagnosis

“…The worldwide prevalence of cancer is increasing in underdeveloped countries, which currently account for 82 % of the total population diagnosed with cancer, and 70 % of cancer-related deaths globally (7).…”