PROJECT SUMMARY/ABSTRACT
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. Moreover, this K23 will support additional training in advanced biostatistics and
quantitative data analysis, research methodology, and clinical training in the workup, treatment, and
management of anemia. These activities, under the guidance and support of a strong mentorship team, will
allow me to develop scientifically and professionally, so that at the end of this K23 award period I will be
prepared to use the data collected to apply for an RO1 to support an RCT that I would lead as an independent
investigator. This planned RCT would build on the data and scientific foundation established as part of this
K23, and would compare symptom-driven transfusion to the current practice of uniform restrictive transfusion
practice based on Hb alone, using fatigue, activity, and fatigability as outcomes. Therefore, through the
training, mentoring, and research experience of this award, I will position myself to become an independent
researcher and a leader in how transfusion affects important patient-reported and clinical outcomes in
hospitalized patients with anemia. Additionally, I will set myself up to be a leader in the future who studies how
new and emerging therapies affect and can improve the health outcomes of hospitalized patients with anemia.