title: [Red blood transfusion in palliative care situation].
abstract: Anemia is frequent in oncology. We debate the decision-making process of erythrocyte transfusion in palliative care situation from a case report. A patient with a prostatic metastatic cancer was in palliative situation with asthenia and coronary symptom. We analyze, in this particular case that does not describe reality of normal practice, the decision-making process of erythrocyte transfusion. These transfusions were based, in this case, on the evaluation of oncology prognosis, the short-term vital threats, life project and clinical safety of the transfusion. The patient has received 5 erythrocyte transfusions in 4 months until a multidisciplinary meeting decided to stop transfusion because of poor prognostic situation and bad tolerance of the act. This patient could be a collegial model used to measure the reasonable nature of prescription depending on the purpose and the goal of the patient but does not allow generalization. Although there is low risk of erythrocyte shortage, it seems important to train doctors to reduce abusive transfusion and define transfusion thresholds. Different levels of erythrocyte transfusion security would raise the issue of management of several stocks. Erythrocyte transfusion in palliative care can be considered subject to prognostic information and the palliative aim of the transfusions, multidisciplinary decision-making, during short hospitalizations and with evaluation of the act and consequences for the patient.
authors: Clinique dermatologique, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; Laboratoire d'éthique médicale, université Paris Descartes, 45, rue des Saints-Pères, 75006 Paris, France. Electronic address: charles.velter@chru-strasbourg.fr.
authors: C
authors: C
authors: Velter
authors: Médecine palliative, hôpital Cochin, AP-HP, université Paris Descartes, 123, boulevard de Port-Royal, 75014 Paris, France.
authors: V
authors: V
authors: Montheil
authors: Cancérologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Descartes, 123, boulevard de Port-Royal, 75014 Paris, France.
authors: J
authors: J
authors: Alexandre
authors: Médecine palliative, hôpital Cochin, AP-HP, université Paris Descartes, 123, boulevard de Port-Royal, 75014 Paris, France.
authors: P
authors: P
authors: Vinant
authors: Cancérologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Descartes, 123, boulevard de Port-Royal, 75014 Paris, France.
authors: F
authors: F
authors: Goldwasser
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000150:complications / Q000556:secondary; D000368:Aged; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D001859:Bone Neoplasms / Q000097:blood / Q000150:complications / Q000556:secondary; D000066491:Clinical Decision-Making; D003327:Coronary Disease / Q000150:complications; D018450:Disease Progression; D034462:Dissent and Disputes; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000941:ethics*; D015658:HIV Infections / Q000150:complications; D006760:Hospitalization; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010166:Palliative Care / Q000941:ethics*; D057240:Patient Preference; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications; D011788:Quality of Life; D018454:Spouses / Q000523:psychology; D028761:Withholding Treatment / Q000941:ethics*
keywords: Cancérologie; Decision-making process; Erythrocyte transfusion; Ethics; Médecine palliative; Oncology; Palliative care; Processus décisionnel; Transfusion de concentrés de globules rouges; Éthique