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National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice

Neoh, Karen; Gray, Ross; Grant-Casey, John; Estcourt, Lise; Malia, Catherine; Boland, Jason W.; Bennett, Michael I.

Authors

Karen Neoh

Ross Gray

John Grant-Casey

Lise Estcourt

Catherine Malia

Jason W. Boland

Michael I. Bennett



Abstract

Background:
Red blood cell transfusions are commonly used in palliative care to treat anaemia or symptoms caused by anaemia. In patients with advanced disease, there is little evidence of benefit to guide treatment decisions in the face of increased risk of harms.

Aim:
To determine national transfusion practice in hospices and compare this against National Institute for Health and Care Excellence and British Society of Haematology guidelines to develop recommendations to improve practice.

Design and Setting:
Prospective data collection on red blood cell transfusion practice in UK adult hospices over a 3-month census period.

Results:
A total of 121/210 (58%) hospices participated. A total of 465 transfusion episodes occurred in 83 hospices. Patients had a mean age of 71 years, and 96% had cancer. Mean pre-transfusion haemoglobin was 75 g/L (standard deviation = 11.15). Anaemia of chronic disease was the largest cause of anaemia (176; 38%); potentially amenable to alternative treatments. Haematinics were not checked in 70% of patients. Alternative treatments such as B12, folate and iron were rarely used. Despite transfusion-associated circulatory overload risk, 85% of patients were not weighed, and 84% had two or more units transfused. Only 83 (18%) patients had an improvement maintained at 30 days; 142 (31%) had less than 14 day improvement, and 50 (11%) had no improvement. A total of 150 patients (32%) were dead at 30 days.

Conclusion:
More rigorous investigation of anaemia, increased use of alternative therapies and more restrictive approach to red cell transfusions are recommended. Clinicians should discuss the limited benefit versus potentially higher risks with patients in hospice services to inform treatment decisions.

Journal Article Type Article
Publication Date Jan 1, 2019
Journal Palliative Medicine
Print ISSN 0269-2163
Electronic ISSN 1477-030X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 33
Issue 1
Pages 102-108
APA6 Citation Neoh, K., Gray, R., Grant-Casey, J., Estcourt, L., Malia, C., Boland, J. W., & Bennett, M. I. (2019). National comparative audit of red blood cell transfusion practice in hospices: Recommendations for palliative care practice. Palliative medicine, 33(1), 102-108. https://doi.org/10.1177/0269216318801755
DOI https://doi.org/10.1177/0269216318801755
Keywords Anesthesiology and Pain Medicine; General Medicine
Publisher URL http://journals.sagepub.com/doi/10.1177/0269216318801755

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