title: The transfusion trigger and number of units transfused in patients with HIV: associations with disease stage and functional status.
abstract: BACKGROUND
  The influence of quality of life (QOL), physical functioning, and HIV disease stage on the transfusion trigger and the number of units transfused was investigated.
  
  
  METHODS
  The Viral Activation Transfusion Study, a randomized, double-blind study at 11 participating sites, enrolled HIV-positive patients with anemia who required RBC transfusion; 428 patients were included in the analysis of the first transfusion. The QOL scores, Perceived Health Index, Karnofsky score, CD4+ cell count, HIV viral load, and site were analyzed for relationships with the Hb level and the number of units transfused.
  
  
  RESULTS
  The transfusion trigger was lower in patients with higher levels of Karnofsky score, Perceived Health Index, CD4+ cell count, and a number of QOL scales. Both the Hb trigger and the number of units transfused had a significant site variation. Males were transfused at a significantly lower Hb level than females. In multivariate analysis, the CD4+ cell count remained significant, but the Karnofsky score or the Perceived Health Index did not. The number of RBC units transfused was associated with the Hb level, CD4+ cell counts, and Karnofsky scores in unadjusted analysis but with only Hb in adjusted analysis.
  
  
  CONCLUSIONS
  In this group of HIV+ patients, lower CD4+ cell counts prompted transfusion at higher Hb levels. However, after controlling for the Hb level, the number of units transfused was associated with only the Hb level. The HIV stage appears to influence the decision to transfuse at a particular Hb level but not to influence the number of RBC units transfused. The functional status does not appear to influence the decision to transfuse.
authors.affiliation: Ohio State University, Columbus, USA. kennedy-2@medctr.osu.edu
authors.forename: Melanie S
authors.initials: MS
authors.lastname: Kennedy
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Kalish
authors.forename: Kala
authors.initials: K
authors.lastname: Mohandas
authors.forename: Terry
authors.initials: T
authors.lastname: Gernsheimer
authors.forename: Dee
authors.initials: D
authors.lastname: Townsend-McCall
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001803:Blood Transfusion; D018791:CD4 Lymphocyte Count; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000503:physiopathology* / Q000628:therapy*; D006304:Health Status; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012727:Sex Characteristics
chemical_list: D006454:Hemoglobins