The effect of red blood cell transfusion on fatigability after hospital discharge

Abstract

In patients with anemia, there is interest in understanding the impact of red blood cell (RBC) transfusion on patient-reported outcomes such as fatigue. However, data from previous studies are mixed as to whether transfusion improves fatigue. One explanation for this is that prior studies have not examined whether changes in fatigue from transfusion may also affect patient activity levels. This is important because if transfusion reduces fatigue, patients may become more active, which could increase their fatigue. Thus, testing whether transfusion affects patients’ fatigability, a measure of fatigue in the context of activity, may be more useful than testing the effect of transfusion on fatigue alone. The objective of this study was to test the effect of transfusion during hospitalization on patients’ fatigability 7 days postdischarge. This prospective observational study included hospitalized general medicine patients with hemoglobin levels <10 g/dL. Patient-reported fatigability was collected during hospitalization and by telephone 7 days after discharge. Multivariable linear regression was used to test the association between receipt of a transfusion and fatigability 7 days postdischarge. Among the 350 patients participating, larger reductions in fatigability were observed with more transfused RBCs. Receipt of 1 U of RBCs was associated with a smaller reduction in fatigability, whereas receipt of 2 to 3 U of RBCs was associated with reductions in fatigability nearly 1 standard deviation from baseline and 3 times greater than patients receiving 1 U of RBCs. In hospitalized patients with anemia, receipt of a transfusion is associated with reductions in fatigability 7 days after hospital discharge.

Iron status and burden of anemia in children with recessive dystrophic epidermolysis bullosa

“…Anemia that was unresponsive to parenteral iron was also managed by PRBC transfusions, which anecdotally improved anemia‐associated fatigue in many of our patients. Two prior studies showed that hospitalized adults on a general medicine service with Hgb <9–10 g/dL with high baseline fatigue had posttransfusion reduction in fatigue that lasted for 7–30 days after discharge 15,16 …”

“…Two prior studies showed that hospitalized adults on a general medicine service with Hgb <9-10 g/dL with high baseline fatigue had posttransfusion reduction in fatigue that lasted for 7-30 days after discharge. 15,16 Patients with RDEB and anemia are often treated with enteral iron, which can be poorly tolerated due to nausea and constipation. It is unclear if most RDEB patients on enteral iron have normal iron absorption, and iron absorption tests can be considered to inform management.…”

Patient-reported Outcomes and Quality of Life in Anemic and Symptomatic Patients With Myelofibrosis: Results From the MOMENTUM Study

“…8,10 However, fatigue is complex and multifactorial, and patients' activity levels and patient experience data (timing and duration of fatigue) must also be taken into account to accurately assess fatigue. 11 Although JAK inhibitors are a mainstay of MF treatment, some approved JAK inhibitors (eg, ruxolitinib and fedratinib) do not address and may even exacerbate anemia, depending on disease phenotype, and none are specifically indicated to treat disease-associated anemia, potentially contributing to fatigue burden. 12,13 Momelotinib is a JAK inhibitor that blocks JAK1, JAK2, and activin A receptor type 1 (ACVR1) and has previously demonstrated clinical activity against anemia, symptoms, and splenomegaly in MF clinical trials.…”

“…While drivers of fatigue in MF are diverse, including cytokine dysregulation and deconditioning, anemia may contribute to the weakness and fatigue experienced by patients 8 , 10 . However, fatigue is complex and multifactorial, and patients’ activity levels and patient experience data (timing and duration of fatigue) must also be taken into account to accurately assess fatigue 11 …”

Clinical practice for outpatients that are chronically red cell dependent: A survey in the Netherlands

“…The effect of this individualized transfusion policy is hard to quantify and depends on the haemoglobin (Hb) threshold, the timing of transfusion and the number of RBC units administrated [ 6 , 7 , 16 ]. Factors like anaemia related symptoms, the (estimated) cardiopulmonary compensation capacity and the presence of iron overload might further influence the transfusion policy [ 17 , 18 ]. The lack of clarity on thresholds and targets to be used for transfusion, will easily result in either under or over transfusion in these patients.…”