Affiliation:
1. Students’ Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
2. Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland, Transfusion Committee, University Clinical Center of Medical University of Silesia in Katowice, Katowice, Poland
Abstract
<b>Introduction:</b> The prevalence of preoperative anemia is highest in the group of colorectal cancer (CRC) patients and may reach over 75%. The prevalence of anemia in CRC patients increases even further following surgery. Approximately 75-80% of anemic CRC patients present with absolute or functional iron deficiency (IDA). Preoperative anemia constitutes an independent risk factor for allogeneic blood transfusion (ABT), postoperative complications, prolonged length of hospital stay, and increased mortality. Allogeneic blood transfusion is itself associated with increased morbidity and mortality.<b>Aim:</b> The aim of this review article was to present the pathophysiology and the current approach to diagnosis and treatment of preoperative IDA in CRC patients.<b>Material and methods:</b> Extensive search of medical literature databases was performed (Pubmed, Embase). The key words that were used were as follows: colorectal cancer, colorectal surgery, iron-deficiency, iron-deficiency anemia, intravenous iron, Patient Blood Management.<b>Results:</b> There are several laboratory parameters that can be used for IDA diagnosis, however the simplest and cost-effective is reticulocyte hemoglobin equivalent. Pathophysiologic features of IDA in CRC patients favor treatment with intravenous, as oppose to oral, iron formulations. Applying Patient Blood Management strategies minimizes the exposure to ABT.<b>Conclusions:</b> Preoperative IDA is highly prevalent among CRC patients. Preoperative anemia is an independent risk factor for ABT, increased morbidity and mortality, as well as prolonged hospital length of stay. The same negative consequences are associated with ABT. Therefore preoperative IDA in CRC patient needs to be screened for, diagnosed, and treated before surgery. Effective treatment of preoperative IDA in CRC patients is with intravenous iron formulations. Allogeneic blood transfusion should be the treatment of last resort due to risk of negative clinical consequences, including increased rate of cancer recurrence.