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Background: Red Blood Cell (RBC) transfusions are commonly used in palliative care. RBCs are a finite resource, transfusions carry risks, and the net effect (benefits and harms) is poorly defined for people with life-limiting illnesses.

Objective: To examine the indications and effects of RBC transfusion in palliative care patients.

Design: This international, multisite, prospective consecutive cohort study.

Setting/Subjects: Palliative care patients undergoing RBC transfusion.

Measurements: Target symptoms (fatigue, breathlessness, generalized weakness, or dizziness) were assessed before transfusion and at day 7 by treating clinicians, using National Cancer Center Institute Common Terminology Criteria for Adverse Events. Assessment of harms was made at day 2.

Results: One hundred and one transfusions with day 7 follow-up were collected. Median age was 72.0 (interquartile range 61.5–83.0) years, 58% men …