Anaesthetic considerations for patient blood management in cancer surgery: a narrative review.

Anaemia is a common and constant challenge in oncology. Many patients treated for cancer suffer from undiagnosed and untreated anaemia and may receive unnecessary blood transfusions, despite existing guidelines. Transfusion can lead to increased morbidity and mortality, longer hospital stays, and higher costs, all in a dose-dependent manner. Patient Blood Management (PBM) is founded on three key pillars: managing anaemia, reducing blood loss, and improving tolerance to anaemia. These strategies should be implemented before, during, and after surgery. PBM programmes have proven to be effective in lowering transfusion rates and should be applied to every patient undergoing cancer-related surgery. As a standard of care, PBM could significantly enhance patient safety and long-term outcomes in a multidisciplinary surgical and medical oncology context. However, adherence to these recommendations remains insufficient. Key considerations during cancer surgery include: 1. Preoperative detection of anaemia and iron deficiency (ferritin <100 µg/L and/or <transferrin saturation <20%), along with potential intravenous iron supplementation (depending on the product available). 2. Adherence to established transfusion guidelines (for oncology hospitalised adult patients who are hemodynamically stable and have no heart conditions, transfuse only when the haemoglobin concentration is less than 70 g/L). 3. Prevention of iatrogenic and unnecessary blood loss. 4. Utilisation of erythropoiesis-stimulating agents (to be discontinued once haemoglobin levels reach 120 g/L). 5. Administration of antifibrinolytic agents. 6. Use of cell-salvage techniques (with leukodepletion filter). A successful PBM programme requires time to reach optimal efficiency, and the involvement of multidisciplinary teams is essential to improve the quality of treatment.