Transfusion practices at end of life for hematopoietic stem cell transplant patients
- 230 Downloads
Limited data exist regarding transfusion practices at end of life (EOL) for hematopoietic stem cell transplant (HSCT) patients. The purpose of this study was to examine red blood cell (RBC) and platelet transfusion practices in HSCT patients who enrolled or did not enroll in hospice.
This was a single-center, retrospective chart review in deceased HSCT patients. The primary objective was to determine the mean difference between the last transfusion and death in HSCT patients (n = 116) who enrolled or did not enroll in hospice.
Sixteen (14%) and 100 (86%) patients were enrolled in hospice and not enrolled in hospice, respectively. Hospice patients observed a larger mean difference between death and last transfusion (45.9 ± 66.7 vs. 14.6 ± 48.1 days, p < 0.0001). A higher amount of platelet, but not RBC, transfusions occurred in patients not enrolled in hospice (p = 0.04). The last transfusion that occurred more than 96 h before death was observed in 12 (75%) and 22 (22%) in hospice and non-hospice patients, respectively. For HSCT patients not enrolled in hospice, 17 patients received a transfusion on the same day of death and 31 patients received the last transfusion 24 h before death.
Blood transfusion practices differed in HSCT patients enrolled and not enrolled in hospice. For most patients not enrolled in hospice, the last transfusion occurred 24 h before death. Future efforts should explore if limited access to blood products is a barrier to hospice enrollment for HSCT patients.
KeywordsHematologic malignancies Stem cell transplantation Blood transfusion Hospice End of life
This study was presented in part at the 2016 ASCO Palliative and Supportive Care in Oncology Symposium, San Francisco, CA, 2016.
Dr. Roeland’s research is supported by a UC San Diego Clinical Translational Research Institute KL2 Career Development Award (#KL2TR001444) and Cambia Health Foundation Sojourns Scholars Leadership Program.
Compliance with ethical standards
Conflict of interest
The authors declare that they no conflict of interest.
- 6.Howell DA, Shellens R, Roman E, Garry AC, Patmore R, Howard MR (2011) Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data. Palliat Med 25(6):630–641. https://doi.org/10.1177/0269216310391692 CrossRefGoogle Scholar
- 9.Toner RW, Pizzi L, Leas B, Ballas SK, Quigley A, Goldfarb NI (2011) Costs to hospitals of acquiring and processing blood in the US: a survey of hospital-based blood banks and transfusion services. Appl Health Econ Health Policy 9(1):29–37. https://doi.org/10.2165/11530740-000000000-00000 CrossRefGoogle Scholar
- 15.Wang WS, Ma JD, Nelson SH, Revta C, Buckholz GT, Mulroney CM, Roeland EJ (2017) Advance care planning and palliative care integration for patients undergoing hematopoietic stem-cell transplantation. J Oncol Pract Am Soc Clin Oncol 13(9):e721–e728. https://doi.org/10.1200/JOP.2016.020321 CrossRefGoogle Scholar