To Timothy H M, LeBlanc Thomas W, Eastman Peter, Neoh Karen, Agar Meera R, To Luen Bik, Rowett Debra, Vandersman Zac, Currow David C
1 Palliative and Supportive Services, Flinders University , Adelaide, Australia .
2 Southern Adelaide Palliative Services, Repatriation General Hospital , Adelaide, Australia .
J Palliat Med. 2017 Oct;20(10):1152-1157. doi: 10.1089/jpm.2017.0072. Epub 2017 Jun 9.
Red Blood Cell (RBC) transfusions are commonly used in palliative care. RBCs are a finite resource, transfusions carry risks, and the net effect (benefits and harms) is poorly defined for people with life-limiting illnesses.
To examine the indications and effects of RBC transfusion in palliative care patients.
This international, multisite, prospective consecutive cohort study.
SETTING/SUBJECTS: Palliative care patients undergoing RBC transfusion.
Target symptoms (fatigue, breathlessness, generalized weakness, or dizziness) were assessed before transfusion and at day 7 by treating clinicians, using National Cancer Center Institute Common Terminology Criteria for Adverse Events. Assessment of harms was made at day 2.
One hundred and one transfusions with day 7 follow-up were collected. Median age was 72.0 (interquartile range 61.5-83.0) years, 58% men, and mean Australia-modified Karnofsky Performance Status (AKPS) of 48 (standard deviation [SD] 17). A mean 2.1 (SD 0.6) unit was tranfused. The target symptoms were fatigue (61%), breathlessness (16%), generalized weakness (12%), dizziness (6%), or other (5%). Forty-nine percent of transfusions improved the primary target symptom, and 78% of transfusions improved at least one of the target symptoms. Harms were infrequent and mild. An AKPS of 40%-50% was associated with higher chances of symptomatic benefit in the target symptom; however, no other predictors of response were identified.
In the largest prospective consecutive case series to date, clinicians generally reported benefit, with minimal harms. Ongoing work is required to define the optimal patient- and clinician-reported hematological and functional outcome measures to optimize the use of donor blood and to minimize transfusion-associated risk.
红细胞（RBC）输血常用于姑息治疗。红细胞是一种有限的资源，输血存在风险，对于患有危及生命疾病的患者，其净效应（益处和危害）尚不明确。
研究姑息治疗患者红细胞输血的指征和效果。
这项国际多中心前瞻性连续队列研究。
设置/研究对象：接受红细胞输血的姑息治疗患者。
治疗医生在输血前和第7天使用美国国立癌症研究所不良事件通用术语标准评估目标症状（疲劳、呼吸困难、全身无力或头晕）。在第2天评估危害情况。
收集了101次输血且随访至第7天的病例。中位年龄为72.0（四分位间距61.5 - 83.0）岁，男性占58%，澳大利亚改良卡氏功能状态评分（AKPS）平均为48（标准差[SD]17）。平均输注2.1（SD 0.6）单位。目标症状为疲劳（61%）、呼吸困难（16%）、全身无力（12%）、头晕（6%）或其他（5%）。49%的输血改善了主要目标症状，78%的输血改善了至少一种目标症状。危害不常见且轻微。AKPS为40% - 50%与目标症状出现症状性改善的可能性较高相关；然而，未发现其他反应预测因素。
在迄今为止最大的前瞻性连续病例系列研究中，临床医生普遍报告有获益，且危害最小。需要持续开展工作来确定最佳的患者和临床医生报告的血液学和功能结局指标，以优化供血的使用并将输血相关风险降至最低。
