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

• Published in: Quality of life research 2020-10, Vol.29 (10), p.2737-2744
• Main Authors: Bruhn, Roberta, Karafin, Matthew S., Hilton, Joan F., Kaidarova, Zhanna, Spencer, Bryan R., Qu, Lirong, Snyder, Edward L., Olin, Rebecca, Murphy, Edward L., St. Lezin, Elizabeth
• Format: Article
• Language: English
• Subjects: Aged; Erythrocyte Transfusion - adverse effects; Fatigue - etiology; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Outpatients; Prospective Studies; Public Health; Quality of Life - psychology; Quality of Life Research; Sociology
• ISSN: 0962-9343; 1573-2649
• DOI: 10.1007/s11136-020-02517-2

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.