Prescribing and Deprescribing Blood Component Therapy in Advanced Cancer and End-of-life Care: Moving beyond Laboratory Thresholds

When Transfusion Thresholds Meet End-of-Life RealityBlood component therapy remains an important component of supportive oncology care.Red blood cell (RBC) transfusions, platelet support, fresh frozen plasma, and cryoprecipitate are routinely used to manage hematological complications of advanced malignancy.While evidence-based transfusion thresholds are well established for the general medical population, their application in patients with advanced cancer and end-of-life care remains challenging. 1s palliative care becomes increasingly integrated into oncology practice, clinicians frequently face difficult decisions regarding continuation of transfusion support in patients with limited life expectancy.The central question is not whether transfusions can improve symptoms, but rather which patients are most likely to benefit and when deprescribing should be considered.Anemia affects nearly 70-80% of patients with advanced cancer and contributes significantly to fatigue, weakness, and dyspnea.Systematic reviews suggest that blood transfusions may provide short-term symptomatic improvement in selected patients receiving palliative care. 2,3However, the available evidence indicates that benefits are often transient, typically lasting only a few days to 2 weeks. 4,5hese observations highlight an important principle: correction of laboratory abnormalities should not be considered synonymous with clinical benefit.In patients approaching the end of life, interventions should primarily be judged on their ability to improve comfort, quality of life, and achievement of patient-centered goals.