OKLAHOMA CITY – A first-of-its-kind study from the University of Oklahoma found that hospice agencies can provide blood and platelet transfusions at home for patients with blood cancers who are no longer pursuing aggressive treatment. The approach allowed patients to receive transfusions for symptom relief without repeated trips to a hospital or clinic, giving them more opportunity to spend time with loved ones.
Published in eClinicalMedicine, a journal in The Lancet family, the study addresses a barrier to hospice care for patients with blood cancers: the difficulty of accessing transfusions after they stop pursuing treatment aimed at controlling their cancer.
Although Medicare covers blood and platelet transfusions in other care settings, hospice agencies face financial barriers to providing them as part of hospice care. As a result, patients who want hospice services may continue traveling to hospitals or clinics for transfusions that can take hours to complete.
Jennifer Holter-Chakrabarty, M.D., a hematologist-oncologist at OU Health Stephenson Cancer Center and professor of hematology-oncology at the OU College of Medicine, launched the study to determine whether home-based transfusions could improve patients’ quality of life. She hopes the findings will help support a federal reimbursement model that would allow hospice agencies to offer the service.
“If patients want to transition to hospice, the need for transfusions doesn’t go away,” she said. “Patients often feel exhausted and are short of breath, but after they get a unit of blood, they may have enough energy to get up and make a meal or spend time with their family. They get more of their life back.”
The study, which enrolled 20 people, found that hospice-administered blood and platelet transfusions kept patients’ hemoglobin and platelet levels within a range consistent with clinical transfusion guidelines. No patients were admitted to the hospital or intensive care unit, and no transfusion reactions were reported. In addition, researchers calculated that providing the transfusions at home cost $571 per patient per week – an amount far less than if the transfusion were provided in a hospital, Holter-Chakrabarty said.
Patients in the study spent an average of 11 days in hospice, compared with a six-day average reported for patients with blood cancers who receive hospice care. The findings suggest that offering transfusions through hospice may help address a barrier to accessing end-of-life care.
“Patients with blood cancers like leukemia or myeloma have a much higher likelihood of dying in the hospital or ICU instead of getting to die at home,” Holter-Chakrabarty said. “In this study, all of the patients we approached wanted to take part in the study, and all of our patients were able to die at home. They had the peace of being around people they love.”
The study also used patients’ symptoms to help determine when they received transfusions, rather than relying solely on laboratory results. In hospitals and clinics, transfusions are generally guided by blood test results, including hemoglobin and platelet levels. But patients can experience different symptoms at the same levels, Holter-Chakrabarty said. Each week of the study, patients received blood products based on an evaluation of symptoms like fatigue, shortness of breath, bruising or bleeding.
“We wanted to flip the script and give the patient control,” she said. “Because the study was designed to deliver palliative, patient-centered care, we felt like the patients’ symptoms should trigger a transfusion, not a number. At the end of the study, we were glad to see that their numbers stayed in the same range as they would have been in a hospital or clinic.”
The study was a collaboration with Our Blood Institute, based in Oklahoma City, which provided the blood, lab testing and nursing staff to perform transfusions, as well as two local hospices, Integris Hospice and Apex Home Health and Hospice, which oversaw care and collected data.
John Armitage, M.D., president and CEO of Our Blood Institute, said the study aligned with the organization’s mission to improve health and quality of life.
“Our Blood Institute was honored to collaborate with Dr. Holter-Chakrabarty and her team to establish the efficacy, safety and practicality of streamlined transfusions for hospice patients needing blood products for their comfort and quality of life,” Armitage said. “We hope this study will open a pathway for many more patients and families to access humane, end-of-life care in the home or local environments that best meet their needs. We know our blood donors will rejoice knowing that their gifts can support patients and families in such a supportive and meaningful way.”
Holter-Chakrabarty serves as a councilor and previously served as the government affairs chair for the American Society of Hematology, which has advocated nationally for reimbursement to cover home-based transfusions.
“If transfusions were covered, more patients with blood cancers would feel comfortable with hospice once they are no longer pursuing aggressive treatment,” she said. “We believe our study has shown that hospices can safely deliver transfusions, with an improvement in hospice care. As a physician, it was gratifying to see patients and their families spend quality time at home. We took something that was frustrating for families and turned it into something comforting.”
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About the project
The study, “Home-based transfusions in hospice patients with hematologic malignancies: a pilot study,” is at https://doi.org/10.1016/j.eclinm.2026.104305. Additional authors are Rabia Saleem, M.D., (first author); Joshua Glover, M.D.; Sara K. Vesely, Ph.D.; John Armitage, M.D.; Mohamad Khawandanah, M.D.; Andrew Cohoon, MPH; Silas A. Day, MS; Daniela Miladinova, M.D.; Barbara Ledford, BS; Michael Stevenson, M.D.; Carrie Yuen, M.D.; Bryan Struck, M.D.; Sarah K. Minor, D.O.; Stefani T. Madison, M.D.; and Ryan D. Nipp, M.D. (senior author).
The research was supported by the National Cancer Institute Cancer Center Support Grant P30CA225520 awarded to OU Health Stephenson Cancer Center. Support for OU Health Stephenson Cancer Center’s programs includes funding from the Tobacco Settlement Endowment Trust (TSET), among other sources.
About the University of Oklahoma
Founded in 1890, the University of Oklahoma is a public research university with campuses in Norman, Oklahoma City and Tulsa. As the state’s flagship university, OU serves the educational, cultural, economic and healthcare needs of the state, region and nation. In Oklahoma City, the OU Harold Hamm Health Campus is one of the nation’s few academic health centers with seven health profession colleges located on the same campus. The OU Harold Hamm Health Campus serves approximately 4,000 students in more than 70 undergraduate and graduate degree programs spanning Oklahoma City and Tulsa and is the leading research institution in Oklahoma. For more information about the OU Harold Hamm Health Campus, visit www.ouhsc.edu.