Transfusion dependence (TD) usually describes patients receiving regular platelet and/or red blood cell (RBC) transfusions more frequently than every eight weeks, due to persistently low counts. The need for transfusion is most commonly associated with myelodysplastic syndrome, myeloproliferative neoplasms, and leukemias.
Many patients with life-prolonging goals of care regularly establish the need for transfusion based on a diagnostic threshold (e.g., hemoglobin < 7), rather than a specific symptom. As TD patients near the end-of-life, they often face emotionally-wrought decisions about the continued role of transfusions.
Potential benefits of continuing transfusions
• Patients may receive significant improvement in fatigue and dyspnea within hours from RBC transfusions when hemoglobin levels are < 7. These benefits likely dissipate after 13 days.
• Platelets transfusions can stop or prevent bleeding caused by severe thrombocytopenia within hours but usually have a lifespan of only 4-8 days.
Potential harms of continuing transfusions
• Organ damage from iron overload can result from multiple transfusions.
• Logistical complexities do not allow transfusions to be done in a patient’s home.
Discontinuing transfusions can be a challenging instance to discuss, as patients can be overwhelmed by their overall medical situation, and patient and families may worry about inciting imminent death from discontinuing transfusions.
See reference for more information.
Adapted from Gergi M. Soriano-Pisaturo. Palliative care issues for transfusion-dependent patients. Palliative Care Network of Wisconsin. Fast facts and concepts #359. Internet. Accessed on January 8, 2019.