Atharva Zhainagul
In general internal medicine wards, palliative care patients—those with at least one chronic, lifelong medical condition—and hospice patients—those with less than six months to live—are frequently admitted. This review aims to provide the internist with a strategy for dealing with bleeding in this population by using a clinical case. First, some helpful guidance on platelet transfusions will be given. Second, the treatment of bleeding in site-specific circumstances (including cutaneous ulcers, gastrointestinal-urogenital tract bleeding, and ENT/pulmonary bleeding) will be covered. Finally, a management algorithm for catastrophic bleeding is suggested. In conjunction with regional recommendations, electronic databases such as EMBASE, Pubmed, Google Scholar, and the Cochrane Library were studied as primary resources to find papers examining platelet transfusions and alternative management of site-specific bleeding in palliative care patients. Palliative care patients in the internal medicine ward frequently experience hemorrhagic complications. Current recommendations call for only therapeutic platelet transfusions. Prophylactic and/or therapeutic transfusion, however, must still be decided by a doctor. On the advice of experts and case studies, site-specific therapeutic options are developed. Even though invasive procedures might be necessary in some circumstances, their use must be consistent with the objectives of the patient. The presence of comforting careers is essential during catastrophic bleeding; drug management comes second.