Monti M, Castellani L, Berlusconi A, Cunietti E
Palliative Care Unit (Hospice), Pio Albergo Trivulzio Geriatric Institute, Milan, Italy.
J Pain Symptom Manage. 1996 Jul;12(1):18-22. doi: 10.1016/0885-3924(96)00044-9.
Anemia is often associated with neoplastic disorders. Blood transfusions are used to alleviate the discomfort of anemic cancer patients. Of 246 terminally ill cancer patients admitted to our palliative care unit from October 1991 to December 1993 (128 women and 118 men), 31 patients (12.6%) (17 men and 14 women; age, 69.5 +/- 12 years) received on average 2.8 units of packed red blood cells (PRBCs) (range, 2-7 units/patient) in 35 separate admissions. PRBCs were transfused in the presence of low hemoglobin (Hb) levels ( < or = 8 g/dL) and/or severe fatigue or dyspnea. Pre-transfusion performance status, cognitive function, dyspnea, and fatigue at rest (evaluated by a four-point scale), complete blood count, serum albumin, and C-reactive protein were determined. The day after transfusion, subjective well-being was recorded as "yes/no" improvement in comparison with the pre-transfusion day. Improved subjective well-being after blood transfusion was reported in 51.4%, without significant relationship to pre-transfusion Hb levels or performance status. The influence of blood transfusion on subjective well-being was not related to the severity of dyspnea or fatigue. Twenty-one patients (60%), including seven with subjective improvement, died during the same hospitalization, a median of 49 days after transfusion. Pre-transfusion Hb level did not differ significantly in patients who benefited and did not benefit from transfusion, whereas time before death was significantly (P < 0.001) shorter in patients who did not benefit. In the discharged patients (40%), the median interval between transfusion and discharge was 13 days and the frequency of subjective improvement in well-being was 78.6%. Our data suggest that two main areas should be investigated, namely the relation between low Hb levels and symptoms and signs in terminally ill cancer patients, and the correct timing for effective blood transfusion. A combination of criteria is needed for effective transfusion; they must include not only Hb levels but also type and severity of anemic symptoms and signs. Furthermore, the identification of reliable prognostic indicators for survival would be useful.
贫血常与肿瘤性疾病相关。输血用于缓解贫血癌症患者的不适。在1991年10月至1993年12月期间入住我们姑息治疗病房的246例晚期癌症患者中（128例女性和118例男性），31例患者（12.6%）（17例男性和14例女性；年龄69.5±12岁）在35次单独入院中平均接受了2.8单位的浓缩红细胞（PRBCs）（范围为2 - 7单位/患者）。在血红蛋白（Hb）水平低（≤8 g/dL）和/或严重疲劳或呼吸困难的情况下输注PRBCs。测定输血前的体能状态、认知功能、呼吸困难和静息时的疲劳（通过四点量表评估）、全血细胞计数、血清白蛋白和C反应蛋白。输血后第二天，与输血前一天相比，主观幸福感记录为“改善/未改善”。51.4%的患者报告输血后主观幸福感有所改善，这与输血前的Hb水平或体能状态无显著关系。输血对主观幸福感的影响与呼吸困难或疲劳的严重程度无关。21例患者（60%），包括7例主观有改善的患者，在同一住院期间死亡，输血后中位时间为49天。从输血中受益和未受益的患者输血前Hb水平无显著差异，而未受益患者的死亡前时间显著缩短（P < 0.001）。在出院患者中（40%），输血与出院之间的中位间隔时间为13天，主观幸福感改善的频率为78.6%。我们的数据表明，有两个主要领域需要研究，即晚期癌症患者低Hb水平与症状和体征之间的关系，以及有效输血的正确时机。有效输血需要综合多种标准；这些标准不仅必须包括Hb水平，还应包括贫血症状和体征的类型及严重程度。此外，识别可靠的生存预后指标将很有用。
