The general aim of this thesis was to evaluate the role of iron in anemic patients with solid cancer, with special attention to the long-term oncological effects of iron therapy in the... Show moreThe general aim of this thesis was to evaluate the role of iron in anemic patients with solid cancer, with special attention to the long-term oncological effects of iron therapy in the preoperative setting. In this thesis, this role of iron is specifically studied in the context of colorectal cancer. In chapter 2 the results of a systematic review and meta-analysis demonstrate that preoperative anemia was significantly associated with decreased overall survival and disease-free survival. In the third chapter, results showed that 50 percent of all colorectal cancer patients, and 80 percent of all anemic colorectal cancer patients were iron deficient. In chapter 4 it was shown that a distinct variability was present in preoperative blood management practices not only between, but also within Dutch hospitals. Regarding the efficacy of preoperative intravenous iron therapy, in chapter 5 it was demonstrated that iron therapy is most effective in patients presenting with more severe anemia, and with higher transferrin and lower ferritin levels. In chapter 7, our study failed to demonstrate that preoperative intravenous iron therapy has a profound effect on long-term overall and disease-free survival in anemic colorectal cancer patients. Show less
Chapter 2 describes the results of a RCT on the effect of a restrictive trigger on RBC sparing. In three hospitals, a restrictive transfusion policy was compared with standard care transfusion... Show moreChapter 2 describes the results of a RCT on the effect of a restrictive trigger on RBC sparing. In three hospitals, a restrictive transfusion policy was compared with standard care transfusion policy. A randomised comparison of transfusion triggers in elective orthopaedic surgery using leucocyte-depleted red blood cells was performed. The clinical consequences of this restrictive transfusion policy on post-operative complications and well-being are discussed in Chapter 3. Quality of Life and fatigue scores in relation to postoperative haemoglobin levels were analysed in Chapter 4. In Chapter 5 we investigated the efficacy and feasibility of two types of postoperative drainage and re-infusion systems and compared these to a control group. To evaluate the immuno-modulatory effects of salvaged blood in the post-operative patient, we analysed the effect of autologous salvaged blood re-infusion on the patients__ cytokine gene expression profiles compared to the effect of surgery itself (Chapter 6). Chapter 7 reports the combined strategies of Epo and autologous salvaged blood on RBC use compared to a control group under a restrictive transfusion policy (TOMaat study). In Chapter 8, future trends and ongoing studies are discussed in order to aim for an optimal and Tailor Made Patient Blood Management Program for elective orthopaedic surgery patients. In the final chapter, Chapter 9, an implementation protocol is described to investigate the barriers and facilitators for implementation of the TOMaat study results in daily practice. Show less
