Management of anaemia in palliative care

Anaemia is common in patients with palliative care needs and can significantly impair quality of life. Features of anaemia may relate to the rate of fall of haemoglobin concentration rather than its absolute value, and include:

• breathlessness
• tachycardia and palpitations
• exacerbation of angina
• fatigue and general weakness
• reduced alertness, poor concentration and memory problems
• anorexia.

Anaemia in patients with palliative care needs is often multifactorial. Causes include:

• vitamin and mineral deficiencies
• chronic illness
• bleeding (acute and chronic)
• bone marrow failure
• chemotherapy.

Management of anaemia depends on the cause. Consider the potential benefits and burdens of each intervention, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

Identify and address reversible causes, if possible. See the Gastrointestinal guidelines for management of iron deficiency, vitamin B12 deficiency and folate deficiency.

For patients with significant symptoms of anaemia, consider a blood transfusion for rapid symptom reliefWilcock A, 2020.