Department of Pathology, MSC08 4640, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
Curr Oncol Rep. 2019 Aug 30;21(10):92. doi: 10.1007/s11912-019-0832-0.
The palliative care population is a complex and heterogeneous one. While transfusion therapy is a readily available intervention for many patients, inadequate knowledge for accurately identifying which patient subsets at end-of-life will benefit from a transfusion, along with an unclear understanding of the magnitude of attendant risks of transfusion in those receiving palliative care, complicates the risk-benefit assessment of this therapy. In this brief review, the current literature surrounding transfusion of red cells and platelets in the palliative care patient population will be reviewed and recommendations provided.
Benefits of transfusion therapy include subjective relief of fatigue and dyspnea, and improved sense of wellness, amongst other findings. However, these responses are not durable and there are currently no validated, objective metrics that correlate with symptomatic improvements. It is clear that transfusion-associated adverse reactions are underestimated in those receiving palliative care, with reaction rates similar to the general patient population. Additionally, based on the high mortality rates reported soon after transfusion, the impact of these blood components must be considered as an exacerbating or causative factor of mortality when evaluating declining condition or death. Hematinics are rarely assessed in anemic palliative care patients or, when measured, are often not corrected. The decision to transfuse palliative care patients is multifactorial, and benefits, risks, patient wishes, blood component inventories, and alternatives to transfusion should all be considered. There are many unknowns regarding transfusion in palliative care. Critical next steps for optimizing blood component therapy in this population include high-quality trials that help to identify validated measures of objective functional changes that parallel patient-reported outcomes and subsets of patients receiving end-of-life care that will most likely be positively impacted by transfusion therapy.
姑息治疗人群是一个复杂且异质的群体。虽然输血治疗是许多患者可获得的干预措施，但对于哪些终末期患者亚组将从输血中受益，以及对接受姑息治疗的患者输血相关风险的程度缺乏清晰的认识，这使得对这种治疗方法的风险效益评估变得复杂。在这篇简短的综述中，将回顾姑息治疗患者群体中红细胞和血小板输血的当前文献，并提供建议。
输血治疗的益处包括主观缓解疲劳和呼吸困难，以及改善整体健康感等。然而，这些反应并不持久，目前没有与症状改善相关的验证性、客观指标。很明显，接受姑息治疗的患者中输血相关不良反应被低估了，其反应率与一般患者群体相似。此外，根据输血后不久报告的高死亡率，在评估病情恶化或死亡时，必须将这些血液成分的影响视为死亡的加重或促成因素。在贫血的姑息治疗患者中很少评估血液生化学指标，或者即使测量了，也往往得不到纠正。决定是否为姑息治疗患者输血是一个多因素的问题，应考虑输血的益处、风险、患者意愿、血液成分库存以及输血的替代方案。在姑息治疗中输血有许多未知之处。优化该人群中血液成分治疗的关键下一步包括高质量的试验，这些试验有助于确定与患者报告的结果相平行的客观功能变化的验证性测量方法，以及最有可能受益于输血治疗的终末期护理患者亚组。
