# Restrictive Blood Transfusion Policy for the Management of Anemia in Palliative Care in Finland

## TL;DR

This study explores how Finnish palliative care physicians manage anemia, finding that restrictive blood transfusion policies are commonly used with limited alternative treatments.

## Contribution

The paper provides insights into anemia management practices in Finnish palliative care, highlighting the need for national guidelines.

## Key findings

- Less than 25% of patients received red blood cell transfusions, with hemoglobin levels typically below 78 g/L.
- Transfusions were based on symptoms like fatigue and weakness, without systematic symptom severity assessments.
- Only a third of respondents believed national guidelines would be helpful despite a lack of current ones.

## Abstract

Restrictive blood transfusion policy has been shown to be effective in managing anemia. However, treatment of anemia in palliative (PC) and end-of-life (EOL) care remains understudied. The aim of this study was to examine Finnish PC physicians’ attitudes and practices in the management of anemia.

A structured questionnaire asking clinicians about how they treat anemia in PC was developed with a focus on blood transfusion. In addition, a previously published collection of clinical case scenarios was included. Physician’s recall of their use of red blood cell (RBC) transfusions in 2021 was also asked. The questionnaire was first delivered at an annual meeting of the Finnish Association for Palliative Medicine in 2022 and subsequently, a Webpropol form was emailed to the members of the society.

A total of 94 (28%) doctors at an average age of 46.5 years responded. Of these 80% were specialists and 75% had a special competence in palliative medicine. RBC transfusions were given in less than 25% of patients, average hemoglobin was b ≤ 78 g/L. Transfusions were given for clinical symptoms such as fatigue, angina, and weakness without systematic measurement of symptom severity. Hematinic levels were investigated, but iron was given seldom. Clinical scenarios were answered similarly as previously in the UK. National guidelines for anemia in early PC or EOL care are lacking but would be deemed to be helpful by one-third of those who completed the questionnaire.

Physicians apply the restrictive policy in blood transfusions for PC patients in Finland. Other treatments for anemia are not often used. Both prospective studies and national guidelines are needed.