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Palliative Care



Non-Pain Symptoms


Anemia and Blood disorders:

Many of the signs and symptoms seen in pediatric cancers are due to the effect on the bone marrow.  The causes are:

  • Direct marrow involvement by the cancer
  • the treatment’s suppression of the marrow’s production of red blood cells, white blood cells and platelets.

This increases the risk of associated symptoms such as infection, fatigue, breathlessness, and bleeding and can be problematic for the child and those who care for them(5).

In advanced cancer, the effectiveness and length of response to transfusion often decreases with progressive deterioration of the patient. At some point, it simply is not worth the effort or risk(4).



Blood and platelet transfusions can be given for severe anemia, thrombocytopenia and bleeding.

However, some considerations should be discussed in the use of blood transfusions in palliative care, as M. Downing(4) describes:

                                 Repeated Transfusions in Advanced Cancer

Repeated transfusions are warranted if:

  • Patient is ambulatory and clear benefit was obtained following the last transfusion


Transfusion is Not warranted if:

  • Patient is imminently dying
  • Patient declines transfusion
  • Previous untoward systemic reaction
  • No benefit from previous transfusion
  • Patient is already bed bound and will not regain ambulation with transfusion



It is important to consider that repeated transfusions in areas without the capacity for transfusions at home, requiring the child to be in hospital for intermittent and extended periods of time, may not be how the child and/or family want to spend the remainder of the child’s life(5).

Also a sedation plan should be discussed with the family if severe bleeding occurs in order to minimize distress.






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