Blood transfusions for anaemia in palliative care

National Blood Authority, 2012

The National Blood Authority Patient Blood Management Guidelines provide guidance on appropriate use of blood transfusions. Before starting transfusions for symptomatic management of anaemia:

• clarify the goals of transfusion with the patient and carers
• consider the burden and potential benefit of transfusions
• plan for when transfusions will be stopped—see discussion of withdrawing and withholding treatment in palliative care.

It can be difficult to predict if a blood transfusion will improve symptoms of anaemia, or how long improvement will last; response to previous transfusions can be a guide. If there is no improvement, do not repeat transfusions.

Discuss burdens and benefits of repeated transfusion for chronic haematological disorders with patients when the magnitude or duration of effect of transfusions reduces (eg when the symptom-free interval shortens from monthly to fortnightly or weekly). When symptomatic benefit declines or stops, it can be confronting for patients who have received long-term treatment with blood products. They may need to see proof that the transfusion will no longer work. Conduct discussions about withdrawal of transfusions with care; see withdrawing or withholding treatment in palliative care for advice.