Anaemia, or a low level of haemoglobin in the blood, is common in patients receiving palliative care or hospice care. Anaemia may cause symptoms such as fatigue, weakness, shortness of breath, heart palpitations, sleepiness, dizziness, chest pains, and exercise intolerance. If the level of haemoglobin decreases gradually, the body adapts to the situation, in which case anaemia might not cause symptoms that interfere with the patient’s life.
As long as the patient’s life expectancy is measured in months, anaemia that causes symptoms can be treated with red blood cell transfusions. In such cases, treating the anaemia may relieve the patient’s symptoms.
The effects of red blood cell transfusions are usually short-term, resulting in the need for repeated transfusions. Towards the end of life, the same symptoms may also be caused by the patient’s underlying illness, in which case red blood cell transfusions are unhelpful.
Low blood platelet count and platelet transfusions
When cancer spreads to the bone marrow, or the bone marrow is damaged due to treatments, the production of blood platelets (thrombocytes) may be impaired. Since the body adapts to decreased platelet levels, the patient’s platelet count may be quite low (< 10–50 x 109/l) before the risk of serious bleeding increases.
The benefits of platelet transfusions are temporary, only lasting for a few days, and the procedure usually requires hospitalisation. In palliative care, the patient may be given platelet transfusions if the low platelet count causes bleeding.