The purpose of this study is to prospectively study the safety of salvage red blood cell (sRBC) transfusion during pancreatic surgery.

Primary Objective:

1. To summarize rates and timing of septic adverse events (AE) for patients who receive sRBC or aRBC transfusions within 72 hours of peri-operative transfusion.
2. To summarize rates and timing of transfusion related AEs for patients who receive sRBC or aRBC transfusions within 72 hours of peri-operative transfusion.
3. To summarize rates and timing of AEs in the first 7 post-operative days.

Secondary Objectives:

1. To summarize the number of units of aRBC transfused post operative day (POD) #0 after sRBC transfusion in the operating room.
2. To summarize the number of units of aRBC transfused POD#1-7 after sRBC transfusion the operating room, in the absence of overt post-operative hemorrhage.

Inclusion Criteria:

1. Provision of signed and dated informed consent form. Able to understand their disease and the exploratory nature of sRBC transfusion during surgery for this histology.
2. Patient is 18 years of age or older
3. Patient has a diagnosis of cytologically or pathologically confirmed pancreatic adenocarcinoma
4. Patient has an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
5. Patient has an American Society of Anesthesiologists (ASA) classification of physical health status of 1-4
6. Life expectancy of greater than six months
7. Hemoglobin > 8.9 g/dl
8. Platelet count greater than 200,000/mm3
9. International Normalization Ratio ≤1.8
10. Total serum bilirubin ≤ 2 mg/dL
11. Serum creatinine ≤ 1.5 mg/dl
12. Recovered from any hematologic toxicity less than grade 3 from all prior chemotherapy or radiotherapy, and be at least 14 days past the date of their last treatment.

Exclusion Criteria:

1. Concomitant medical problems that would place the patient at unacceptable risk for a major surgical procedure.
2. History of congestive heart failure and/or an LVEF <40%.
3. Metastases
4. Active systemic infections, hematological diseases, coagulation disorders or other major medical illnesses of the cardiovascular, hepatic, renal, respiratory or immune system.
5. Patients with transabdominal drains, or peripancreatic abscess or fluid collections on cross-sectional imaging.

The sample size in this exploratory study is small such that data sharing may risk breaching confidentiality.