The effect of red-blood-cell transfusion on fatigue in hospitalized patients with anaemia

BACKGROUND AND OBJECTIVE

Guidelines suggest that red-blood-cell transfusion decisions for most hospitalized patients be based on haemoglobin (Hb) concentration and the presence of symptoms of anaemia, including fatigue. However, studies differ in whether transfusion is associated with improvements in fatigue. One explanation is that the benefit of transfusion varies by baseline fatigue levels, which existing studies have not examined. The objective of this study was to determine whether the association between transfusion during hospitalization and improvements in fatigue 30 days postdischarge varies by baseline fatigue level.

METHODS

A prospective observational study of hospitalized general medicine patients with any Hb <9 g/dl. Patients with sickle cell anaemia and gastrointestinal bleeding were excluded since these diagnoses have alternative transfusion practices. Patients with depression were excluded because their fatigue is not primarily due to anaemia. Fatigue was measured during an in-person interview and a 30-day postdischarge phone interview. Hb values and receipt of a transfusion were collected from hospital administrative data. Linear regression was used to test associations between 'change in fatigue', Hb concentration and receipt of a transfusion.

RESULTS

Transfusion interacted with nadir Hb was associated with reduced fatigue postdischarge for patients with higher baseline fatigue (20% most fatigued: β = 12, P = 0·02; 10% most fatigued: β = 17, P = 0·02). Patients <50 years old with high baseline fatigue had large reductions in fatigue from transfusion (20%: β = 23, P = 0·02; 10%: β = 29, P = 0·03).

CONCLUSIONS

Transfusion during hospitalization is associated with reduced fatigue 30 days postdischarge in patients with higher levels of baseline fatigue.