Background: Current guidelines recommend transfusing red blood cells in hospitalized patients at “restrictive” hemoglobin (Hb) concentrations and for symptoms of anemia. However, there is little data on how the symptoms of anemia, specifically fatigue, are affected by blood transfusions. Such analyses are complicated because hospitalized patients may experience fatigue due to their acute illness that improves with clinical recovery, irrespective of their Hb concentration or whether they received a transfusion. We sought to measure how fatigue changes in anemic patients from the time of their hospitalization until 30 days after discharge. We also sought to test whether the change in fatigue is associated with baseline Hb concentration during hospitalization and receipt of transfusion.

Methods: From May-November, 2014, all hospitalized general medicine patients with Hb<9g/dL were approached for an in-person interview while in the hospital and a 30-day post-discharge phone interview. Fatigue at each time point was measured by the Functional Assessment of Cancer Therapy Fatigue Subscale (FACT). FACT scores range from 0-52, with lower scores reflecting greater symptoms of fatigue. A “Change in fatigue” score was calculated by subtracting responses on the FACT while hospitalized from responses on the FACT at the 30 day post discharge interview. Chart review assessed the patient’s Hb and number of transfusions received while in the hospital. Linear regression was used to test associations between “change in fatigue”, Hb concentration, and receipt of transfusion.

Results: 221 patients completed the inpatient and follow up interview. There were no differences in demographics or baseline FACT score between patients who received a transfusion and those who did not receive a transfusion. Among patients with high levels of fatigue and Hb<8g/dL, those receiving a transfusion had a clinically significant improvement in fatigue compared to non-transfused patients (p=0.06). Among patients with high levels of fatigue and a Hb>8g/dL, those receiving a transfusion also had clinically improved fatigue compared to patients not transfused, although the difference was not statistically significant. Among patients with low levels of fatigue irrespective of Hb level, no significant difference in change in fatigue was found between those transfused and those not transfused. 

Conclusions: These findings are consistent with the hypothesis that blood transfusions may improve fatigue in hospitalized anemic patients, specifically those with high levels of fatigue. This suggests it may be possible for hospitalists to combine measured fatigue in patients and Hb concentration to target patients more likely to experience reduced fatigue after discharge if they receive a blood transfusion. Future studies should focus on the effect of symptom-guided transfusion strategies on symptoms and other outcomes of hospitalized patients with anemia.