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Early and sustained improvement in fatigue-related quality of life following red blood cell transfusion in outpatients

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Abstract

Purpose

Outpatients with hematologic disease often receive red cell transfusion to treat anemia and fatigue. The effect of transfusion on fatigue-related quality of life and how well this effect is sustained has not been quantified. The study aim was to describe the early and sustained impact over 4 weeks of red cells on patient-reported fatigue in outpatients age ≥ 50 receiving transfusion as routine clinical care.

Methods

FACIT-Fatigue scale scores were measured pre-transfusion and at visits targeting 3, 7, and 28 days post-transfusion. Group-based trajectory modeling of patient fatigue scores by study day was used to identify the number of distinct trajectories (Groups), then longitudinal mixed effects modeling of fatigue scores was used to estimate group-specific mean improvements early after transfusion and between days 3 and 28 post-transfusion.

Results

Four distinct fatigue score trajectory groups were identified and were found to be correlated with baseline fatigue scores (means 12, 26, 34, and 47 points). In the three groups with the lowest fatigue trajectories (indicating greater fatigue), improvements in fatigue early after transfusion achieved the established minimum clinically important difference (≥ 3 points, Group p = 0.0039). In all trajectory groups, mean fatigue levels did not change significantly between 3 and 28 days (± 1 point, Group p = 0.60).

Conclusion

Patient-reported fatigue varies widely among older adult outpatients with hematologic disorders. Nonetheless, trajectory modeling suggests that most anemic patients can expect a noticeable improvement in fatigue in the first few days after transfusion that generally is sustained up to 4 weeks.

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Acknowledgements

The NHLBI Recipient Epidemiology Donor Evaluation Study-III (REDS-III), domestic component, is the responsibility of the following persons: Hubs: A.E. Mast and J.L. Gottschall, BloodCenter of Wisconsin (BCW), Milwaukee, WI; D.J. Triulzi and J.E. Kiss, The Institute for Transfusion Medicine (ITXM), Pittsburgh, PA; E.L. Murphy and E.M. St. Lezin, University of California, San Francisco (UCSF), and Laboratory Medicine, Department of Veterans Affairs Medical Center, San Francisco, CA; E.L. Snyder, Yale University School of Medicine, New Haven, CT; R.G. Cable, American Red Cross Blood Services, Farmington, CT; Data coordinating center: D.J. Brambilla and M.T. Sullivan, Research Triangle International, Rockville, MD; Central laboratory: M.P. Busch and P.J. Norris, Blood Systems Research Institute, San Francisco, CA; Publication committee chair: R.Y. Dodd, American Red Cross, Holland Laboratory, Rockville, MD; Steering committee chair: S.H. Kleinman, University of British Columbia, Victoria, BC, Canada; National Heart, Lung, and Blood Institute, National Institutes of Health: S.A. Glynn and K.B. Malkin, Bethesda, MD.

Funding

This project is part of the NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III), which was funded by NHLBI contracts NHLBI HHSN2682011-00001I, -00002I, -00003I, -00004I, -00005I, -00006I, -00007I, -00008I, and -00009I.

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Authors and Affiliations

  1. Vitalant Research Institute, San Francisco, CA, USA

    Roberta Bruhn, Zhanna Kaidarova & Edward L. Murphy

  2. University of California San Francisco, San Francisco, CA, USA

    Roberta Bruhn, Joan F. Hilton, Rebecca Olin, Edward L. Murphy & Elizabeth St. Lezin

  3. Versiti, Milwaukee, WI, USA

    Matthew S. Karafin

  4. American Red Cross, Scientific Affairs, Dedham, MA, USA

    Bryan R. Spencer

  5. Institute for Transfusion Medicine, Pittsburgh, PA, USA

    Lirong Qu

  6. Yale Medical School, New Haven, CT, USA

    Edward L. Snyder

  7. San Francisco Veterans Affairs Health Care System, Department of Laboratory Medicine 113A, 4150 Clement Street, San Francisco, CA, 94121, USA

    Elizabeth St. Lezin

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Contributions

RB and ESL drafted the manuscript; ZK and JH performed statistical analyses. All other authors contributed significantly to the study design, data acquisition, or critical interpretation of the analyses. All authors reviewed the manuscript for important intellectual content.

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Correspondence to Elizabeth St. Lezin.

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Bruhn, R., Karafin, M.S., Hilton, J.F. et al. Early and sustained improvement in fatigue-related quality of life following red blood cell transfusion in outpatients. Qual Life Res 29, 2737–2744 (2020). https://doi.org/10.1007/s11136-020-02517-2

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