Background. Surgical patients are often anaemic preoperatively subsequently requiring blood transfusion. The aim of this study was to assess the problem of anaemia and transfusion rates in patients undergoing surgery for colorectal cancer. Methods. Haemoglobin levels and transfusion requirements were assessed retrospectively in 199 sequential patients operated on for colorectal cancer. This was followed by prospective analysis of 147 patients to correlate preoperative anaemia, stage of bowel cancer, and operation performed with rates of blood transfusion and length of hospital stay. Results. Preoperatively 44% patients were anaemic retrospectively and 60% prospectively. Anaemia increased the risk of transfusion in both studies (69% anaemic versus 31% nonanaemic, in retrospective series, and 83.7% versus 16.3%, in prospective series). Anaemia was proportionally higher in patients with Dukes B (65.2%) and Dukes C (66.6%) than in patients with Dukes A (28.5%). Length of stay was prolonged in transfused patients excluding those requiring major blood transfusion (median 13 versus 7 days, ). Transfusion was also associated with higher mortality ( ). Conclusion. Anaemia is common in patients with colorectal cancer. Anaemic patients were at high risk of receiving blood transfusion, which in turn increased length of stay and mortality. 1. Introduction Anaemia is common in cancer patients with a reported prevalence of 40% in solid tumours [1, 2]. Overall anaemia in patients presenting with cancer is associated with reduced survival [3, 4] and reduced quality of life [2, 5]. Many lower gastrointestinal tumours present as iron deficiency anaemia [6]. Although anaemia is associated with chronic blood loss from the gastrointestinal tract, malignancy induced inflammation and underlying comorbidities are causal factors for anaemia of chronic disease [7]. Treatment whether surgery, chemotherapy, or radiotherapy may further worsen anaemia [7]. In those patients with colorectal cancer undergoing surgical resection, preoperative anaemia was associated with increased risk of perioperative infection, mortality, and a longer inpatient stay [8–13]. Anaemia is also an independent risk factor for allogenic blood transfusion (ABT) with a reported prevalence of in these cohorts of patients of 10%–38% [14]. Transfusion may further worsen outcome following operation. Effective management of anaemia may result in improved functional quality of life and better response to treatment [6, 15–17]. The aim of this study was twofold: firstly, to assess the relationship between preoperative
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