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

INTRODUCTION: Preoperative 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. METHODS: All 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. RESULTS: Complete 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). CONCLUSION: Haemoglobin 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.