title: Perioperative anemia management in colorectal cancer patients: a pragmatic approach.
abstract: Anemia, usually due to iron deficiency, is highly prevalent among patients with colorectal cancer. Inflammatory cytokines lead to iron restricted erythropoiesis further decreasing iron availability and impairing iron utilization. Preoperative anemia predicts for decreased survival. Allogeneic blood transfusion is widely used to correct anemia and is associated with poorer surgical outcomes, increased post-operative nosocomial infections, longer hospital stays, increased rates of cancer recurrence and perioperative venous thromboembolism. Infections are more likely to occur in those with low preoperative serum ferritin level compared to those with normal levels. A multidisciplinary, multimodal, individualized strategy, collectively termed Patient Blood Management, minimizes or eliminates allogeneic blood transfusion. This includes restrictive transfusion policy, thromboprophylaxis and anemia management to improve outcomes. Normalization of preoperative hemoglobin levels is a World Health Organization recommendation. Iron repletion should be routinely ordered when indicated. Oral iron is poorly tolerated with low adherence based on published evidence. Intravenous iron is safe and effective but is frequently avoided due to misinformation and misinterpretation concerning the incidence and clinical nature of minor infusion reactions. Serious adverse events with intravenous iron are extremely rare. Newer formulations allow complete replacement dosing in 15-60 min markedly facilitating care. Erythropoiesis stimulating agents may improve response rates. A multidisciplinary, multimodal, individualized strategy, collectively termed Patient Blood Management used to minimize or eliminate allogeneic blood transfusion is indicated to improve outcomes.
authors.affiliation: Manuel Muñoz, Transfusion Medicine, School of Medicine, University of Málaga, 29071-Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz
authors.affiliation: Manuel Muñoz, Transfusion Medicine, School of Medicine, University of Málaga, 29071-Málaga, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Gómez-Ramírez
authors.affiliation: Manuel Muñoz, Transfusion Medicine, School of Medicine, University of Málaga, 29071-Málaga, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Martín-Montañez
authors.affiliation: Manuel Muñoz, Transfusion Medicine, School of Medicine, University of Málaga, 29071-Málaga, Spain.
authors.forename: Michael
authors.initials: M
authors.lastname: Auerbach
mesh_terms: D000465:Algorithms; D000740:Anemia / Q000628:therapy*; D001803:Blood Transfusion; D015179:Colorectal Neoplasms / Q000150:complications* / Q000628:therapy*; D004921:Erythropoietin / Q000627:therapeutic use; D005060:Europe; D005260:Female; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D008297:Male; D010100:Oxygen / Q000737:chemistry; D019990:Perioperative Care / Q000009:adverse effects; D059035:Perioperative Period; D011788:Quality of Life
chemical_list: D004921:Erythropoietin; D007501:Iron; D010100:Oxygen
keywords: Allogeneic blood transfusion; Anemia; Colorectal cancer; Erythropoiesis stimulating agents; Intravenous iron; Patient Blood Management