Cancer-related anemia occurs in more than 50% of patients with malignancies and constitutes a common finding in patients with gastrointestinal tract tumors. In the present article we present the possible pathogenetic mechanisms as well as the appropriate clinical and laboratory investigations for the anemia, which is associated with gastrointestinal tract malignancies. Moreover, we conducted a MEDLINE database search between 1992- 2003, focusing on the currently available methods for perioperative correction and treatment of anemia. The currently available evidence suggests that perioperative allogenic blood transfusion is associated with increased rates of postoperative infections and constitutes an independent adverse prognostic factor in gastrointestinal malignancies; autologous blood transfusions are of no clinical benefit compared to allogenic transfusions, as autologous blood is not immunologically neutral; and the shortterm results of erythropoietin (EPO) use remain controversial, while its long-term results remain unknown. Correction of anemia in every patient with resectable gastrointestinal malignancy is mandatory, because it improves surgical stress response, wound healing process and quality of life. Although EPO administration constitutes the treatment of choice for patients receiving chemotherapy and/ or radiotherapy, the best perioperative method for anemia correction remains unknown and further prospective randomized studies are required. From the surgical point of view, any effort for "bloodless surgery" should be attempted.