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Published in: Obesity Surgery 1/2015

01-01-2015 | Original Contributions

Anemia After Roux-en-Y Gastric Bypass. How Feasible to Eliminate the Risk by Proper Supplementation?

Authors: Eduardo del Villar Madrigal, Yvette Neme-Yunes, Diana Clavellina-Gaytan, Hugo A. Sanchez, Maureen Mosti, Miguel F. Herrera

Published in: Obesity Surgery | Issue 1/2015

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Abstract

Background

Anemia after Roux-en-Y gastric bypass (RYGB) has been reported in 5 to 64 % of patients. Since absorption of specific elements is reduced, proper supplementation is mandatory. The aim of this study was to investigate the frequency of anemia, its causes, and the related deficiencies during the 1st postoperative year after RYGB.

Methods

A retrospective review of our prospectively collected database was performed. A total of 486 patients who underwent RYGB in a 5-year period and completed at least 1-year follow-up were included. Daily supplements as suggested by the AACE/TOS/ASMBS guidelines were routinely prescribed. Blood count, iron profile, folic acid, and B12 measurements 1 year after surgery were reviewed.

Results

One hundred ninety-five males and 291 females were included, with a mean age of 39.9 ± 11.6 years and a mean body mass index (BMI) of 42.4 ± 6.3 kg/m2. Anemia 1 year after surgery was found in 19 patients (4 %), 6 males and 13 females. In seven women, it was related to iron deficiency. Two additional women had iron deficiency combined with low vitamin B12. Anemia was secondary to inflammation in two and indeterminate in two. In the six males, the cause of anemia was inflammation in three and indeterminate in three. Abnormal bleeding was found in five of these patients.

Conclusions

Frequency of anemia 1 year after RYGB in our population was low (4 %). Anemia non-attributable to malabsorption was frequently present (n = 9/19). Iron deficiency was found exclusively in women. The most common non-malabsorptive types of anemia were inflammation and dysfunctional uterine bleeding.
Literature
1.
2.
go back to reference Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.PubMedCrossRef Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.PubMedCrossRef
3.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
4.
go back to reference Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.PubMedCrossRef Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.PubMedCrossRef
5.
go back to reference Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.PubMedCrossRef Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.PubMedCrossRef
6.
go back to reference DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American society for metabolic and bariatric surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2010;6:347–55.PubMedCrossRef DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American society for metabolic and bariatric surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2010;6:347–55.PubMedCrossRef
7.
go back to reference Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8:544–56.PubMedCrossRef Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8:544–56.PubMedCrossRef
8.
go back to reference Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26:1031–7.PubMedCrossRef Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26:1031–7.PubMedCrossRef
9.
go back to reference Cable CT, Colbert CY, Showalter T, et al. Prevalence of anemia after Roux-en-Y gastric bypass surgery: what is the right number? Surg Obes Relat Dis. 2011;7:134–9.PubMedCrossRef Cable CT, Colbert CY, Showalter T, et al. Prevalence of anemia after Roux-en-Y gastric bypass surgery: what is the right number? Surg Obes Relat Dis. 2011;7:134–9.PubMedCrossRef
10.
go back to reference Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.PubMedCrossRef Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.PubMedCrossRef
11.
go back to reference Aarts EO, van Wageningen B, Janssen IM, Berends FJ. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes. 2012;2012:193705.PubMedCentralPubMedCrossRef Aarts EO, van Wageningen B, Janssen IM, Berends FJ. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes. 2012;2012:193705.PubMedCentralPubMedCrossRef
12.
go back to reference Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9:159–91.PubMedCrossRef Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9:159–91.PubMedCrossRef
13.
go back to reference Wisse BE. The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol. 2004;15:2292–800.CrossRef Wisse BE. The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol. 2004;15:2292–800.CrossRef
14.
go back to reference FAO, WHO. World declaration and plan of action for nutrition. International Conference on Nutrition. Rome, Food and Agriculture Organization of the United Nations, December 1992. FAO, WHO. World declaration and plan of action for nutrition. International Conference on Nutrition. Rome, Food and Agriculture Organization of the United Nations, December 1992.
15.
go back to reference WHO, UNICEF, UNU. Iron deficiency anaemia: assessment, prevention and control, a guide for programme managers. Geneva: World Health Organization; 2001. WHO, UNICEF, UNU. Iron deficiency anaemia: assessment, prevention and control, a guide for programme managers. Geneva: World Health Organization; 2001.
16.
go back to reference Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006;331:207–13.PubMedCrossRef Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006;331:207–13.PubMedCrossRef
17.
go back to reference Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6.PubMedCrossRef Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6.PubMedCrossRef
18.
go back to reference von Drygalski A, Andris DA, Nuttleman PR. Anemia after bariatric surgery cannot be explained by iron deficiency alone: results of a large cohort study. Surg Obes Relat Dis. 2011;7:151–6.CrossRef von Drygalski A, Andris DA, Nuttleman PR. Anemia after bariatric surgery cannot be explained by iron deficiency alone: results of a large cohort study. Surg Obes Relat Dis. 2011;7:151–6.CrossRef
19.
go back to reference Salgado Jr W, Modotti C, Nonino CB, Ceneviva R. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis. 2013;10(1):49–54.PubMedCrossRef Salgado Jr W, Modotti C, Nonino CB, Ceneviva R. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis. 2013;10(1):49–54.PubMedCrossRef
20.
go back to reference Brolin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after Roux-en-Y gastric bypass? J Gastrointest Surg. 1998;5:436–42.CrossRef Brolin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after Roux-en-Y gastric bypass? J Gastrointest Surg. 1998;5:436–42.CrossRef
21.
go back to reference Malone M, Alger-Mayer S, Lindstrom J, Bailie GR. Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study. Surg Obes Relat Dis. 2013;9:969–74.PubMedCrossRef Malone M, Alger-Mayer S, Lindstrom J, Bailie GR. Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study. Surg Obes Relat Dis. 2013;9:969–74.PubMedCrossRef
22.
go back to reference Majumder S, Soriano J, Louie Cruz A, Dasanu CA. Vitamin B12 deficiency in patients undergoing bariatric surgery: preventive strategies and key recommendations. Surg Obes Relat Dis. 2013;9:1013–9.PubMedCrossRef Majumder S, Soriano J, Louie Cruz A, Dasanu CA. Vitamin B12 deficiency in patients undergoing bariatric surgery: preventive strategies and key recommendations. Surg Obes Relat Dis. 2013;9:1013–9.PubMedCrossRef
24.
go back to reference Chen M, Krishnamurthy A, Mohamed AR, Green R. Hematological disorders following gastric bypass surgery: emerging concepts of the interplay between nutritional deficiency and inflammation. Biomed Res Int. 2013;2013:205467.PubMedCentralPubMed Chen M, Krishnamurthy A, Mohamed AR, Green R. Hematological disorders following gastric bypass surgery: emerging concepts of the interplay between nutritional deficiency and inflammation. Biomed Res Int. 2013;2013:205467.PubMedCentralPubMed
25.
26.
go back to reference Tussing-Humphreys L, Pustacioglu C, Nemeth E, Braunschweig C. Rethinking. Iron regulation and assessment in iron deficiency, anemia of chronic disease, and obesity: introducing hepcidin. J Acad Nutr Diet. 2012;112:391–400.PubMedCentralPubMedCrossRef Tussing-Humphreys L, Pustacioglu C, Nemeth E, Braunschweig C. Rethinking. Iron regulation and assessment in iron deficiency, anemia of chronic disease, and obesity: introducing hepcidin. J Acad Nutr Diet. 2012;112:391–400.PubMedCentralPubMedCrossRef
28.
go back to reference Ahmad DD, Esmadi M, Hammad H. Malnutrition secondary to non-compliance with vitamin and mineral supplements after gastric bypass surgery: what can we do about it? Am J Case Rep. 2012;13:209–13.PubMedCentralPubMedCrossRef Ahmad DD, Esmadi M, Hammad H. Malnutrition secondary to non-compliance with vitamin and mineral supplements after gastric bypass surgery: what can we do about it? Am J Case Rep. 2012;13:209–13.PubMedCentralPubMedCrossRef
Metadata
Title
Anemia After Roux-en-Y Gastric Bypass. How Feasible to Eliminate the Risk by Proper Supplementation?
Authors
Eduardo del Villar Madrigal
Yvette Neme-Yunes
Diana Clavellina-Gaytan
Hugo A. Sanchez
Maureen Mosti
Miguel F. Herrera
Publication date
01-01-2015
Publisher
Springer US
Published in
Obesity Surgery / Issue 1/2015
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-014-1356-1

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