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ELI5: a relative is in end of life care for terminal cancer in the hospital and received a blood transfusion today. I was just wondering why?
BiologySymptomatic relief, if he's breathless because his haemoglobin is only 20, giving him blood will make him FEEL better. End of life care is all about managing symptoms and not prolonging life.
Had to google the units of measurement for england real quick. You made me do a double take
How many freedomglobins is he supposed to have?
10-16. Don't start a transfusion unless it's below 7.
Nurses beg for a redraw whenever their hemoglobin is below 7 😂😂😂 if it’s like 6.8 they will try whatever method they can to get that to 7 or above.
Nurses beg for a redraw whenever their hemoglobin is below 7 😂😂😂 if it’s like 6.8 they will try whatever method they can to get that to 7 or above.
1776, of course. Like all red-blooded Americans
9 eagles and 11 hotdogs.
About treefitty amber waves of grain
anything under 1776 is considered low.
The US measurement is g/dL so it might be the uk using non-metric
g/L is metric too.
I was really confused by the hemoglobin of 20, but then realized the way you spelled it.
Just 20 big ol' hemoglobins in there, rattling around like ping pong balls
[slaps hospice patient]
“You can fit so many hemoglobins in grampa!”
They may have also filed specific paperwork on what is and isn't to be done for expected situations.
If you know you're dying and intervention won't prolong your life, or would seriously degrade your quality of life, you can inform your medical providers of your wishes. The great part about that is that it overrides every other request. So if "daughter from California syndrome" arises, you don't need to worry about someone keeping you "alive" against your will.
If we are talking days left, I have never seen someone suggest a blood transfusion. I'd consider it borderline unethical. At that point you will be mostly bedridden anyway. Dying is uncomfortable anemia may be part of that. Correcting anemia in that case is just prolonging that suffering. Relive the symptoms with morphine etc instead.
Blood as palliative care can absolutely make sense, but in the final few days, no.
In general I agree, perhaps there was a big contraindication to opioids which we are unaware of.
Totally agreed.
Comfort care. If his blood oxygen is low he might have been feeling even worse anxiety than expected. Partial suffocation is truly awful.
This. I've felt this. Exhaustion and not being able to quite catch your breath like you had just climbed several flight of stairs. Except you haven't. You've been on your back because even sitting up is exhausting.
I have never been down transfusion level (under 7) but I've come very close.
And a blood transfusion will be immediate relief. Even iron infusions take weeks to fully kick in.
I've been under 4, it is very uncomfortable. Feels like there's no oxygen in the air among other things
this happens when my blood pressures excessively high, it has gotta be the most stressful thing someone can feel
Yup. I had blood clots in my lungs and ended up in the hospital, barely able to breathe for days. Resting heart rate of 160 (at 25).
A year later I tried going for a run, and it went okay-ish. But it was a little warm out and a slight incline as I walked home, and I kept breathing heavily. Ended up with a panic attack on the grass.
The lowest my O2 sat has ever been was 89 and that felt exhausting as it is. It's such a traumatic experience to feel like you can't breathe
And for that you give morphine not a blood transfusion... Its unethical really
Morphine actually helps stop the discomfort associated with shortness of breath. It affects the way the brain perceives it. Its not used for pain in the lower doses for shortness of breath. It can be super effective!
I would like an explanation why im getting downvoted but wtv.
For the same reason someone can be given radiation for palliative care—it isn’t to cure the disease (past that stage generally) but might shrink the tumor a bit to alleviate pain. The person may feel breathless, or so tired they cannot think/talk/walk, so a transfusion is a low intervention way to improve the quality of their last days, should that be what they desire.
Depends on how close to the end they are. Usually the Medical Power of Attorney has the final say how long or how much they allow the hospital to do.
My wife recently had to decide for her father. They had a DNR (do not resuscitate) for him, so the hospital put him in hospice and the asked what was allowed as they had him on antibiotics to help. She ended the antibiotics after the first night, because it was mostly to get her brother in town so he could say his goodbyes.
So maybe the POA or the rest of the family is not ready to say goodbye yet.
In hospice people is only given treatment for painful symptoms. And things like low blood pressure, low blood count, etc. can cause quite a lot of pain. For example shortness of breath, the feeling of drowning, strong headaches, etc. There may even be issues with administering pain killers like morphine due to low blood pressure. So blood transfusions are permitted to reduce the pain in the last days of someones life. This way they can die of things that is far less painful.
It’s not to save them or prolong their life, but to make them suffer less from the process of dying.
Yes, they will die either way, but that bag of blood will make the dying less painful.
Being severely anemic is uncomfortable. They get short of breath, super fatigued, and cold. If the goal is comfort focused care, and he was uncomfortable from his anemia, then giving blood is appropriate
Depends on the cancer and the treatment regimen, but transfusions are common in cancer treatment. For example, when treating blood cancers a transfusion is necessary because the disease and treatment damages the patient's blood to a degree that it can hinder the body's functions.
In this case, it sounds like blood is not being produced efficiently due to the cancer, and a transfusion can help relieve symptoms and help deliver medicine to keep them comfortable.
Few possible reasons
In the hospital setting, unless your relative/family has chosen full comfort care/hospice, medical providers still treat everything.
If they are full comfort care/hospice, giving blood is a bit of a stretch, but the rules are purposely left grey to allow for such things. Most would just give morphine if the anemia is causing them to feel short of breath, but giving blood certainly can improve quality of life as well.
It is possible the doctor talked with your relative and discussed their wishes and this is their wish.
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9d
A DNR does not mean do not treat, it only means that in the event a person's heart stops that CPR will not be performed. Any and all treatment up to point can be given.
When a person enters the dying process, their organs are beginning to shut down. Their kidneys would not be able to filter the extra fluid and giving additional IV fluids could overload their heart, causing fluids to back up into their lungs which could worsen suffering.
As someone else mentioned, a blood transfusion could be a comfort measure if the person's hemoglobin was critically low causing them to feel exhausted and short of breath. It would not be done with the intention of prolonging life but improving the quality of what is left.
Is it possible there are loved ones they want to say goodbye to? Sometimes people try to hold out to have that opportunity. Perhaps it was needed to relieve pain.
My SIL worked in dialysis, and patients would be put through various procedures when they were days from imminent death. There's a lot of money in them there procedures.
Prolong. Death would have come sooner without the transfusion.
Yeah. The answer is that simple.
Why prolong? ...well, more complicated question.
Improving QoL isn't the same thing as prolonging suffering. Quite the opposite in fact.
In europe, it depends on the country.
Here in italy, we prolong if quality of life is somewhat good. No use making a suffering patient live in agony, unless there is a long term solution. Also, say theres surgery with a low chance to give you a bit more time, but higher chance to worsen what you have, we wont do it.
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