Objectives Preoperative anemia is one of the most prevalent yet preventable negative prognostic factors in newly diagnosed gynecologic oncology patients. However, it is often inadequately diagnosed and treated. The aim of this study was to evaluate the prevalence of preoperative anemia in gynecologic oncology patients and characterize types of anemia in this population.
Methods This was a prospective cohort study of all consecutive women consented for gynecologic oncology surgery at Sunnybrook Health Sciences Centre between November 1, 2020-February 1, 2021. CBC, ferritin and iron indices were measured within 10 days of consent(range, 0–10 days). Anemia was defined as Hb <120g/L, absolute iron-deficiency as ferritin <30ng/mL, absolute iron-deficiency in inflammatory setting as ferritin 30–100ng/mL with transferrin saturation(TSAT)<20%, low iron stores as ferritin <100ng/mL with TSAT >20% and functional iron-deficiency as ferritin <300ug/L with TSAT <20%.
Results 133 patients were included. Anemia occurred in 32%(n=43) of patients. It affected 56% of patients with ovarian cancer, 37% with endometrial cancer, 5% with cervical cancer and 6% with vulvar cancer. The overall mean Hb level was 126g/L(range,71–152g/L). The overall prevalence of mild(110–119g/L), moderate(80–109g/L) and severe(<80g/L) anemia were 42%, 47% and 12% respectively. Functional iron-deficiency anemia was the most common cause of anemia(33%), followed by absolute iron-deficiency(21%). 8%(n=10) had received neoadjuvant chemotherapy.
Conclusions One third of patients undergoing gynecologic oncology surgery had anemia. Populations of focus should include ovarian and endometrial cancer patients, due to high rate of preoperative moderate to severe anemia and potential for improvement. This represents an opportunity for patient-safety initiatives.
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