The Effect of Red Blood Cell Transfusion on Fatigue, Activity and Fatigability in Hospitalized Patients with Anemia
PI: Micha Prochaska, Department of Medicine (Hospital Medicine)
Dates: 9/1/2015 - 8/31/2018
Grant #: FP066453
Description: Recent shifts in practice towards restrictive transfusion strategies in hospitalized patients with anemia have been made without clear and convincing evidence concerning the potential adverse effects on fatigue and functional outcomes. This is important because anemia increases the tendency to become fatigued at any given level of activity (fatigability), increasing fatigue and decreasing activity, which may ultimately impair functional outcomes. Given this, the goals of transfusion may include reducing fatigability, minimizing fatigue and increasing activity, which should be expected to improve functional outcomes. Thus, data on the effects of transfusion on fatigue, activity, and fatigability could inform the design of new transfusion strategies that may improve patient outcomes. One example is symptom-driven transfusion, in which patients would be transfused based on their symptoms, such as fatigue. Therefore, this proposal will 1) provide data for hospitalized patients on the effects of transfusion on fatigue, activity levels, and fatigability, and 2) create and validate a new fatigability instrument that can be used in future studies to measure fatigue, activity, and fatigability in patients, and identify those most likely to benefit from a transfusion. The knowledge acquired through this K23 proposal will fill critical gaps in the understanding of how transfusion affects fatigue as the primary and most significant symptom of anemia, activity as an important clinical outcome, and fatigability as a key mediator of effects on both fatigue and activity. This understanding can improve transfusion practice and ultimately outcomes for hospitalized patients with anemia, by providing evidence that helps clinicians and patients better weigh the potential benefits of transfusion on fatigue, activity, and fatigability, against the risks of unnecessary transfusion during hospitalization.