An analysis of quality of life and functional outcomes as reported in randomized trials for red cell transfusions

Abstract

BackgroundMeta‐analyses of randomized controlled trials (RCTs) evaluating thresholds for red blood cell (RBC) transfusion typically focus on mortality; however, other outcomes are highly relevant. The aim of this study is to summarize the effects of different transfusion thresholds on the outcomes of quality of life (QoL) and function.Study DesignWe extracted data from RCTs identified in a recently published Cochrane systematic review. Primary analysis was descriptive.ResultsA total of 23 RCTs with 13,743 adult participants were included. Fifteen RCTs included patients in the postoperative period, of which 9 RCTs were conducted in hip (n = 3024) and 6 (n = 8672) in cardiac surgeries; 5 RCTs (n = 489) were in patients with hematological malignancies; 2 in the setting of bleeding (gastrointestinal bleed [n = 936] and postpartum [n = 521]); and one RCT (n = 936) included critically ill patients. QoL and function were reported using a variety of questionnaires and tools. The timing of assessments varied between trials. No clear clinical differences in QoL outcomes were identified in comparisons between restrictive and liberal transfusion thresholds.DiscussionThere is no evidence that a liberal transfusion strategy improves QoL and functional outcomes. However, the substantial limitations of many included studies indicate the need for further well‐designed and adequately powered trials.

The 2023 AABB international guidelines for red blood cell transfusions: What is new?

“…Further, current evidence is insufficient to determine the optimal hemoglobin thresholds to improve quality of life and functional outcomes. 14 In addition to hemoglobin concentration, a patient's underlying condition, goals, and preferences should be taken into consideration to determine transfusion needs.…”

Effect of different red cell transfusion thresholds on quality of life: An important question with no clear answer yet

“…In this issue of TRANSFUSION, Pagano and colleagues address a very important clinical question: does a restrictive or liberal approach to red blood cell (RBC) transfusion impact the quality of life of medical and surgical patients requiring RBC transfusion? They provide a comprehensive and fascinating analysis of quality of life and functional outcomes from randomized trials of liberal or restrictive RBC transfusion strategies 2 . In their analysis, the authors have summarized the data from 23 trials involving 13,743 adult participants in an attempt to determine a differentiating effect of a straightforward intervention (restrictive vs. liberal transfusion threshold) on a complex outcome (quality of life).…”