The post-operative management of anaemia: more efforts are needed

Abstract

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Anaemia, defined by the World Health Organization (WHO) as a haemoglobin concentration <13 g/dL for men and <12 g/dL for women1, is a very common complication in the immediate post-operative period, being present in up to 90% of patients after major surgery2. Post-operative anaemia may be multifactorial in origin, with pre-existing anaemia, peri-operative blood loss, frequent blood sampling and inadequate nutritional intake after surgery all potentially having a role3. In cancer patients undergoing surgical resection of a tumour, post-operative anaemia is an almost invariable finding related, besides the above-mentioned causes, to chronic blood losses, especially in patients with colorectal cancer, and to previous or concomitant chemotherapy and/or radiotherapy4. In addition, inflammation-related increased hepcidin levels inhibit intestinal iron absorption and iron release from stores thus aggravating the already present iron deficiency anaemia5. Peri-operative anaemia has a deleterious effects on patients' health being associated with prolonged hospitalisation, an increased rate of post-operative complications (especially infections) and, finally, a worsened survival. [ … ]