Factors affecting patient‐reported outcomes after red blood cell transfusion in medical patients

Abstract

BACKGROUND Physical variables like mortality or cardiac events were used to evaluate the requirement of red blood cell (RBC) transfusion. However, patient‐reported outcomes (PROs) of blood transfusion recipients were seldom assessed. The health‐related quality of life (HRQoL) of patients before and after RBC transfusion was compared in this study. STUDY DESIGN AND METHODS The study period was February to June 2016. Standardized generic and anemia symptom‐specific HRQoL instruments were administered to patients receiving RBC transfusion in the medical unit of a single center. The primary outcome was the change in HRQoL scores on Days 1 and 7 posttransfusion from baseline values on the day of transfusion (Day 0). Multiple linear regression analysis was performed to study the effect of transfusion strategy and other factors on PRO. RESULTS The analysis included 99 general medical patients. The median (interquartile range) pretransfusion hemoglobin level was 72 (66‐78) g/L. Two or more units of RBCs were prescribed to 45 patients (45%) on Day 0. Functional Assessment of Cancer Therapy‐Anemia Subscale improved significantly on Days 1 and 7 by effect sizes of 0.41 and 0.38, respectively (p < 0.001). Regression analysis showed that lower baseline HRQoL scores were associated with better PRO on both Day 1 and Day 7 (p < 0.001). Transfusion trigger and number of RBC units transfused did not affect the change in HRQoL. CONCLUSION Worse pretransfusion HRQoL is a predictor of improvement in PRO after blood transfusion. There is no evidence that a restrictive transfusion or single‐unit policy jeopardizes PRO.

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

“…Fatigue is a well-known symptom of anemia, and low hemoglobin levels are correlated with worse fatigue and poor quality of life in patients with cancer. [1][2][3] Recent studies of hospitalized general medical service patients indicate that red blood cell (RBC) transfusion improves short-term fatigue in inpatients, [4,5] but whether transfusion in the hospital is associated with a sustained, clinically important improvement after hospital discharge is not clear. [6,5,7] Similarly, few studies have examined whether RBC transfusion improves fatigue in outpatient transfusion recipients.…”

Therapeutic impact of red blood cell transfusion on anemic outpatients: the RETRO study

“…A recent study in a general medical population suggests that RBC transfusion improves patient‐reported outcomes including fatigue and other quality‐of‐life measures . However, the impact of RBC transfusion on physical performance or functional capacity is less certain.…”

Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies

“…Further studies also need to be done to assess if quality of life is affected with single‐unit transfusions. One recent study suggested no difference with single‐unit transfusions, although it may have not been powered to adequately detect a difference …”