Transfusion in Hospice-Palliative Care

Transfusion in hospice and palliative care remains a complex issue as it is viewed as either a futile life-prolonging treatment or a legitimate intervention for symptom relief. These differing views result in inconsistent clinical practices. Anemia is common in terminally ill patients and is associated with fatigue, dyspnea, dizziness, palpitations, cognitive decline, and an impaired quality of life. Although red blood cell transfusion may provide short-term symptomatic improvement in selected patients, its benefits are often transient; repeated transfusions may be necessary, and its effect on patient survival is limited. Additionally, access to transfusion varies considerably across care settings, with relatively greater availability in tertiary hospitals and substantial barriers in many inpatient hospice units and home hospice services due to institutional and logistical constraints. This brief communication described an 88-year-old man with myelodysplastic syndrome whose transfusion-dependent fatigue substantially influenced decisions regarding hospice care. As a nearby hospice facility did not offer transfusion, the patient and family continued long-distance hospital visits to maintain symptom control. Hospice admission was delayed until his condition rapidly worsened. This case demonstrated that transfusion in patients with terminal illness may carry clinical significance not only in relation to survival, but also in providing symptom relief and in shaping patient and family preferences. Therefore, transfusion in hospice and palliative care should be considered case-by-case within an individualized, goal-concordant framework based on symptom burden, prognosis, patient values, treatment burden, institutional feasibility, and ethical principles, supported by shared decision-making and careful reassessment.