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

Barrie D Keeler, Amitabh Mishra, Christiana L Stavrou, Sophia Beeby, J Alastair Simpson, Austin G Acheson, Barrie D Keeler, Amitabh Mishra, Christiana L Stavrou, Sophia Beeby, J Alastair Simpson, Austin G Acheson

Abstract

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.

Keywords: Anaemia; Blood transfusion; Cancer; Preoperative; Surgery.

Figures

Fig. 1
Fig. 1
Scatter-graph illustrating the inverse correlation of tumour size and initial haemoglobin levels.
Fig. 2
Fig. 2
Bar graphs illustrating the treatment time point at which patients received Allogeneic Red Blood cell Transfusion (ARBT) and the number or ARBT units administered for non-anaemic (a) & anaemic patients (b).Where: DOS = day of surgery, POD = Postoperative day.
Fig. 3
Fig. 3
A stacked bar graph illustrating the change in proportion of patients receiving an allogeneic red blood cell transfusion in relation to the haemoglobin level at surgery.

References

    1. Cata J.P., Wang H., Gottumukkala V., Reuben J., Sessler D.I. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br. J. Anaesth. 2013;110(5):690–701. Epub 2013/04/20.
    1. Acheson A.G., Brookes M.J., Spahn D.R. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann. Surg. 2012;256(2):235–244. Epub 2012/07/14.
    1. Shander A., Van Aken H., Colomina M.J., Gombotz H., Hofmann A., Krauspe R. Patient blood management in Europe. Br. J. Anaesth. 2012;109(1):55–68.
    1. Ludwig H., Van Belle S., Barrett-Lee P., Birgegård G., Bokemeyer C., Gascón P. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur. J. Cancer. 2004;40(15):2293–2306.
    1. McClements P.L., Madurasinghe V., Thomson C.S., Fraser C.G., Carey F.A., Steele R.J.C. Impact of the UK colorectal cancer screening pilot studies on incidence, stage distribution and mortality trends. Cancer Epidemiol. 2012;36(4):e232–e242.
    1. COLOR Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–484.
    1. WHO . World Health Organistaion; 2011. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity.
    1. Whittaker M., Goligher J.C. The prognosis after surgical treatment for carcinoma of the rectum. Br. J. Surg. 1976;63(5):384–388. Epub 1976/05/01.
    1. Poston G.J., Tait D., O'Connell S., Bennett A., Berendse S. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ. 2011;343:d6751. Epub 2011/11/15.
    1. Brenner H., Hoffmeister M., Arndt V., Haug U. Gender differences in colorectal cancer: implications for age at initiation of screening. Br. J. Cancer. 2007;96(5):828–831.
    1. McCallion K., Mitchell R.M.S., Wilson R.H., Kee F., Watson R.G.P., Collins J.S.A. Flexible sigmoidoscopy and the changing distribution of colorectal cancer: implications for screening. Gut. 2001;48(4):522–525.
    1. Lidder P.G., Sanders G., Whitehead E., Douie W.J., Mellor N., Lewis S.J. Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery - a prospective, randomised, controlled trial. Ann. R. Coll. Surg. Engl. 2007;89(4):418–421. Epub 2007/05/31.
    1. Goddard A.F., James M.W., McIntyre A.S., Scott B.B., Gastroenterology B.S. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309–1316.
    1. Macdougall I.C. Strategies for iron supplementation: oral versus intravenous. Kidney Int. Suppl. 1999;69:S61–S66. Epub 1999/03/20.
    1. Edwards T.J., Noble E.J., Durran A., Mellor N., Hosie K.B. Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery. Br. J. Surg. 2009;96(10):1122–1128. Epub 2009/09/05.
    1. Simpson J., Ng S., Brookes M., Acheson A. Single dose preoperative administration of intravenous iron corrects iron deficiency anaemia in Colorectal Cancer. J. Blood Disord. Transfus. 2010;1(101)
    1. Keeler B.D., Simpson J.A., Ng S., Tselepis C., Iqbal T., Brookes M.J. The feasibility and clinical efficacy of intravenous iron administration for preoperative anaemia in patients with colorectal cancer. Colorectal Dis. 2014;16(10):794–800. Epub 2014/06/12.

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