Red blood cell transfusion in adult palliative care: a systematic review

Abstract

BACKGROUND The risks and benefits of red blood cell (RBC) transfusion in palliative care patients remain poorly understood. We reviewed the literature to summarize available information on RBC transfusion in this population. STUDY DESIGN AND METHODS We searched electronic databases (MEDLINE, Embase, PsycINFO, CINAHL) from inception through September 2016 to identify studies reporting data on palliative patients receiving RBC transfusion. Original studies that assessed RBC transfusion as an intervention and reported at least one clinical outcome were included. Study characteristics, results on transfusion‐related outcomes, and authors' conclusions on the value of transfusion in palliative patients were abstracted and reported. RESULTS We identified 1839 studies, of which 137 were selected for data extraction and 13 were included (11 case series, one prospective cohort, and one retrospective cohort). Nine studies addressed symptom relief following transfusion using subjective symptom scales, of which eight (89%) indicated some degree of short‐term benefit and one study (11%) showed no benefit. Posttransfusion survival was reported in four studies—one demonstrated prolonged survival in patients receiving RBC transfusion; three had no comparison group. Other outcomes reported included hemoglobin values posttransfusion in four studies and adverse events following transfusion in three studies. CONCLUSIONS In palliative care, RBC transfusion may provide symptom relief and improve subjective well‐being, though the duration and magnitude of this effect, and transfusion‐associated risks specific to this population remain unclear. Currently, no high quality evidence exists to support or guide the use of RBC transfusion in this population. Moreover, the clinical heterogeneity within the palliative population limits the interpretation of most studies.

Therapeutic impact of red blood cell transfusion on anemic outpatients: the RETRO study

“…The observed improvement in unadjusted fatigue scores also is consistent with a small, but clinically important change in quality of life. Previous studies have shown that transfusion helps to mitigate the symptoms associated with anemia, an independent predictor of fatigue in oncology and palliative care patients . The RETRO study provides further evidence that RBC transfusion is associated with short‐term, modest improvement in fatigue in hematology/oncology patients.…”

“…RBC transfusion, while necessary and life‐sustaining in patients with cancer, may not overcome the effect of underlying poor health on the quality of life and functional performance outcomes measured in the study. The finding that the effect of transfusion was limited in patients with increased disease burden may be especially important in transfusion decisions at the end of life in the palliative care setting …”

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

“…The panel decided to use indirect evidence, obtained from 2 published systematic reviews of the literature, neither of which was focused on older adults with AML, to inform this question. 163,164 The first systematic review focused on the effects of RBC transfusions for patients receiving palliative care. 163 The mean age of patients included in the studies ranged from 64 through 70 years, and it was specified (only in some of the studies) that the patients had terminal malignancies or advanced nonmalignant disease.…”

Red blood cell transfusion in palliative care: what are we doing and why are we doing it?

“…In this issue of TRANSFUSION , Chin‐Yee and colleagues report a systematic literature review of red blood cell (RBC) transfusion in patients receiving palliative care . They importantly highlight that, although RBC transfusion may provide symptomatic relief and subjective improvements to some patients, there is a paucity of high‐quality evidence at this time to substantively guide or support the use of this therapy during end‐of‐life care.…”

“…1 They importantly highlight that, although RBC transfusion may provide symptomatic relief and subjective improvements to some patients, there is a paucity of high-quality evidence at this time to substantively guide or support the use of this therapy during end-of-life care. In addition, the risks of RBC transfusion in this unwell, diverse patient population are poorly characterized, making the task of conducting a proper risk-benefit analysis by ordering providers difficult.…”