Early and sustained improvement in fatigue-related quality of life following red blood cell transfusion in outpatients
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Early and sustained improvement in fatigue‑related quality of life following red blood cell transfusion in outpatients Roberta Bruhn1,2 · Matthew S. Karafin3 · Joan F. Hilton2 · Zhanna Kaidarova1 · Bryan R. Spencer4 · Lirong Qu5 · Edward L. Snyder6 · Rebecca Olin2 · Edward L. Murphy2,1 · Elizabeth St. Lezin2,7 · for the NHLBI Recipient Epidemiology and Donor Evaluation Study (REDS)-III Program Accepted: 24 April 2020 © Springer Nature Switzerland AG 2020
Abstract 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. Keywords Patient-reported outcomes · Fatigue · Fatigue-related quality of life · Red blood cells · Transfusion practice
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11136-020-02517-2) contains supplementary material, which is available to authorized users. * Elizabeth St. Lezin [email protected] 1
Vitalant Research Institute, San Francisco, CA, USA
2
University of California San Francisco, San Francisco, CA, USA
3
Versiti, Milwaukee, WI, USA
4
American Red Cross, Scientific Affairs, Dedham, MA, USA
5
Institute for Transfusion Medicine, Pittsburgh, PA, USA
6
Yale Medical School, New Haven, CT, USA
7
San Francisco Veterans Affairs Health Care System, Department of Laboratory Medicine 113A, 4150 Clement Street, San Francisco, CA 94121, USA
Introduction Fatigue is a well-known symptom of anemia, and low hem
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