Hematology and oncology outpatients often receive RBC transfusions to maintain critical hemoglobin (Hb) thresholds, but the impact of these transfusions on quality of life is not well understood. In order to investigate the effectiveness of these transfusions, 208 outpatients aged at least 50 years with a hematologic or oncologic diagnosis were enrolled in the prospective Red Cells in Outpatients Transfusion Outcomes (RETRO) study. All 208 study participants were given three tests the day of transfusion and again 5-10 days post transfusion: the 6-minute walk test distance, fatigue- and dyspnea-related quality of life tests. Overall, patients improved a median of 20 meters in unadjusted walk test distance (IQR, -6 to 47 m; p<0.001), and a median of 3 points in their fatigue score (IQR, -2 to 9; p<0.001). No clinically significant changes were observed in dyspnea scores. Although some patients did not improve, almost 80% of patients who had not received recent cancer treatment showed improvement in either walk test performance (>20 m) or fatigue score (>3 points) after transfusion. Based on multivariable analyses of changes in the walk test, greater gains were predicted in stable patients without recent cancer treatment and a post-transfusion Hb level >8 g/dL. Quality of life considerations along with clinical thresholds may all impact the decision to transfuse hematology/oncology patients.
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