How do you manage patients desiring home hospice but with severe thrombocytopenia and/or anemia due to advanced malignancy?

As a pediatric hematologist/oncologist and pediatric palliative care physician, I can only speak to our approach with children, which may be quite different than the adult world.

In our community, we are not able to provide blood or platelet transfusions in the home. For children who are profoundly thrombocytopenic and anemic, or who are symptomatic at any low level of platelets or hemoglobin, we continue to offer transfusions in our outpatient clinic (or emergency room if the need is acute). We...

Hospice is a type of palliative care delivered for patients with terminal prognosis and life expectancy of 6 months or fewer. Generally, hospice companies will not provide supportive transfusions of packed red blood cells or platelets. Similarly, growth factors are not part of the routine formulary available to patients who enroll with a hospice provider. While families and patients may desire these interventions, transfusions and growth factors generally do not ameliorate symptoms of disease or...

Many factors may play a role, and comorbidities, ability for ambulatory care and transfer and perhaps important projected life-expectancy would be all-important decision-making considerations. For home hospice care, with patients of bleeding risks esp. with critical thrombocytopenia, it is important to counsel them preemptively to relieve their stress should bleeding happened at home setting under hospice, esp if hemoptysis or hematemesis occurred which can be very distraughtly emotional for pat...