Red cell transfusions in patients with cancer in palliative care: a multicentric study.

Background: Anemia is frequent in palliative care, and transfusions are often used to correct it. Research indicates that transfusions are sometimes based solely on hemoglobin levels rather than patients' symptoms and administered in those with very short survival.

Objective: To survey the transfusion practice of Portuguese palliative teams.

Methods: This is a multicentric and retrospective study involving patients who received red blood cell transfusions in 2021, followed by palliative care teams.

Results: Five palliative care teams participated and included 86 patients who underwent 122 transfusion episodes; 49 (57%) were male, and the median age was 76 years (43-100). The median hemoglobin level before transfusion was 7.4 g/dL (3.7-11.5). Symptomatic improvement was observed in 30 (25%) episodes; in 19 (16%), there was no improvement; and the outcome was not recorded in 73 (60%). Fatigue (38%) and low hemoglobin level (37%) were the most common reasons for transfusion. Decisions to transfuse, recorded primarily by one palliative care team, were often made by nonpalliative care doctors concurrently treating these patients, mostly in the emergency department. Those patients had more complications and significantly shorter survival compared with those whose transfusions were decided by palliative care physicians.

Conclusion: The decisions made by palliative care physicians regarding red blood cell transfusion deviated from the recommendations as seen in other similar studies.