A cohort investigation of anaemia, treatment and the use of allogeneic blood transfusion in colorectal cancer surgery

• Exclusion of anaemia is underperformed during initial management of colorectal cancer.
• Anaemia is more frequently associated with larger diameter and right sided tumours.
• When identified, preoperative anaemia is undertreated.
• Reduction in severity of anaemia at surgery is associated with reduced transfusion requirements.

IntroductionPreoperative identification and treatment of anaemia is advocated as part of Patient Blood Management due to the association of adverse outcome with the perioperative use of blood transfusion. This study aimed to establish the rate of anaemia identification, treatment and implications of this preoperative anaemia on ARBT use.MethodsAll patients who underwent elective surgery for colorectal cancer over 18 months at a single Tertiary Centre were reviewed. Electronic databases and patient casenotes were reviewed to yield required data.ResultsComplete data was available on 201 patients. 67% (n = 135) had haemoglobin tested at presentation. There was an inverse correlation between tumour size and initial haemoglobin (P < 0.01, Rs = −0.3). Initial haemoglobin levels were significantly lower in patients with right colonic tumours (P < 0.01). Patients who were anaemic preoperatively received a mean 0.91 units (95%CI 0–0.7) per patient which was significantly higher than non-anaemic patients (0.3 units [95%CI 0–1.3], P < 0.01). For every 1 g/dl preoperative haemoglobin increase, the likelihood of transfusion was reduced by approximately 40% (OR 0.57 [95%CI 0.458–0.708], P < 0.01). Laparoscopic surgery was associated with fewer anaemic patients transfused (P < 0.01).ConclusionHaemoglobin levels should be routinely checked at diagnosis of colorectal cancer, particularly those with large or right sided lesions. Early identification of anaemia allows initiation of treatment which may reduce transfusion risk even with modest haemoglobin rises. The correct treatment of this anaemia needs to be established.