Guidelines from the AABB recommend that the presence of patient symptoms in addition to hemoglobin (Hb) concentration influence the decision to transfuse red blood cells in hospitalized patients with anemia. Intuitively, patients with symptoms from their anemia are more likely to benefit from the increased tissue oxygenation of a transfusion than are patients without symptoms, and evidence suggests that in certain patients receipt of a transfusion while hospitalized reduces patient fatigue, the primary symptom of anemia. Although fatigue is a commonly emphasized outcome and important symptom for patients with anemia, how transfusion affects fatigue is complicated because fatigue is affected by both energy and activity. Interventions that increase energy and activity may increase fatigue through increased exertion, while interventions with no effect on energy can lead to inactivity and deconditioning, which further influences fatigue. Ultimately, how transfusion affects changes in fatigue relative to changes in patients' physical function is a more clinically relevant outcome, but there is limited data describing the effect of transfusion on fatigue relative to physical function. Therefore, understanding how transfusion affects patients' fatigability, a construct that measures fatigue in relation to a defined activity of a specific intensity and duration, is a critical questions that can provide insight into how transfusion while hospitalized may be able to mitigate the role of anemia and fatigue in the disability pathway and affect patients' independent function after hospital discharge.

To use the University of Chicago Hospitalist Project research infrastructure to assess fatigability, fatigue, and functional status among hospitalized patients with anemia during and 30 days after hospitalization and to understand clinical predictors of these measures, including their association with transfusion during hospitalization.

Students will screen all hospitalized medical patients for anemia daily, and approach eligible patients for recruitment into the study. Students will then administer our questionnaires to participating patients. Using the Hospitalist Project infrastructure to follow discharged patients over time, students will call patients 30-days after their discharge from the hospital to re-administer the questionnaires.

STATA

Outcomes Research Workshop