Narrative review of blood management in the cancer patient undergoing surgery

Abstract

: Improvements in cancer screening programmes and diagnostics have meant that many cancers are now identified early in the disease process and therefore surgery can offer a potential cure. The incidence of cancer continues to increase worldwide and as does the need and capability for surgery. All surgery comes with a risk of blood loss and transfusion. Patient blood management (PBM) is now recognised as a multi-disciplinary team approach and has evolved over the last decade. Using a phased framework of pre-, intra- and post-operative pillars it aims to facilitate early identification and treatment of modifiable risk factors for peri-operative blood loss and thus reduce unnecessary blood transfusion. Anaemia is more prevalent in patients with underlying cancer, so the effects of significant peri-operative blood loss can be more profound and leads to increases in morbidity and mortality. Pre-operative anaemia is an independent risk factor for requiring a blood transfusion. Anaemia can arise from a number of causes; primary pathology, adjuvant chemotherapy and malnutrition are particularly prominent in a cancer setting. Pre-operative treatments include the use of blood, erythrocyte stimulating agent and intravenous iron therapy. Whilst allogenic blood transfusion might always remain a necessity where pre-operative anaemia is extreme or where there is catastrophic intra-operative blood loss, attention to early identification and intervention can modify blood usage. Intra-operative strategies for reducing transfusion in surgery may include advanced technologies such as cell salvage. Post-operatively adherence to transfusion threshold guidance can further reduce transfusion requirements.