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.