In advanced hematologic malignancies, transfusion dependence is common in the terminal phase of illness. Palliative transfusions may provide symptom relief for anemia or thrombocytopenia, but there exists within complex hospice, reimbursement, and policy constraints.

High-quality end-of-life care requires clear goals-of-care discussions, time-limited trials when appropriate, and alignment of clinical practice with patient-defined comfort and dignity.