The zero-sum game of transfusion support during EOL care in patients with acute and chronic leukemia. For patients who are not dependent on transfusion, providers are more willing to refer patients to hospice, which increases hospice enrollment with improvements in quality of EOL care and decreases use of resources for patients with leukemia. Conversely, for patients who are dependent on transfusion of blood products, increased provider reluctance leads to decreased enrollment in hospice for EOL care, worse quality of care, and an increase in use of resources during the EOL care.