Anaemia and patient blood management in patients having neck dissections or free flaps for head and neck cancer

Our main aims were to assess haemoglobin (Hb) concentrations from preoperative assessment to discharge from hospital, and to review whichpatients had blood transfusions and compliance with national transfusion guidelines. We studied a consecutive series of 131 patients betweenOctober 2016 and September 2017 who had either neck dissection or resection and free microvascular tissue transfer. Half the patients hadsoft tissue free flaps (n = 65), 26% had composite free flaps (n = 34), and 24% neck dissection only (n = 32). Using the WHO definition ofanaemia, 4% (1/28) of patients who had neck dissections and 19% (16/85) of those who had free flaps were anaemic preoperatively. Themedian (IQR) Hb at discharge was 131 (119–144) g/L for patients who had neck dissections, 103 (95–114) g/L for those who had soft freeflaps, and 95 (90–104) g/L for those who had composite free flaps. No patients who had neck dissection were given a red blood cell (RBC)transfusion, whereas they were given to 26/99 (26%) of those who had free flaps. Hb concentrations were checked after each unit in 31/39transfusions (79%). Concentrations for those who had free flaps fell by about 30 g/L from admission to operation, and only four patientswere given tranexamic acid peroperatively. Postoperatively Hb remained at similar concentrations until discharge, with 23/98 (24%) giveniron orally on discharge. In terms of compliance with blood transfusion guidelines there was a notable absence of the use of tranexamic acidand of iron intravenously. An increase in their use could potentially reduce the number of blood transfusions required and the postoperativeincidence of anaemia, and have a favourable effect on outcomes such as complications, fatigue, and overall quality of life.