Perioperative Blood Product Transfusions in Gastric Cancer Surgery in Finland

Preoperative anaemia is common in gastric cancer patients. Although restrictive blood product transfusion strategies have been introduced, their use in standard practice is not well known. This national register study investigated the perioperative haemoglobin and platelet levels and the use of blood product transfusions in gastric cancer surgery.

In order to improve and unify blood transfusion policies, the Finnish Red Cross Blood Service carried out a project concerning the optimal use of blood products (VOK project). These register data were used to form the patient population containing 70% of blood product transfusions in Finland. Patients undergoing open surgery for gastric cancers were included.

A total of 500 patients were included. Perioperative anaemia was observed in 75% of males and 52% of females. Fifty-one percent of patients received blood transfusions, with a median transfusion trigger point of 91 g/L [IQR 84-98 g/L] and a median 3 units transfused [IQR 2-4 units]. Seven percent received platelet transfusion (median trigger 77, IQR 15-146; median 4 units, IQR 2-8), and 6.5% received either fresh frozen plasma or pooled human plasma products. At discharge, the median haemoglobin level was 109 g/L in non-transfused patients and 114 g/L in transfused patients. If restrictive strategies had been applied, only 1.7% (n = 9) had required blood and 0.5% (n = 3) had a platelet transfusion.

Anaemia is common among patients undergoing gastric cancer surgery. We encourage clinicians to follow restrictive transfusion policies in gastric cancer patients as Hb levels seem to recover after gastric surgery without blood transfusions.