Skip to main content
Top
Published in: Obesity Surgery 1/2013

01-01-2013 | Clinical Research

Hematological Variables and Iron Status in Abdominoplasty After Bariatric Surgery

Authors: Juan Carlos Montano-Pedroso, Elvio Bueno Garcia, Ivan Rene Viana Omonte, Mario Guilherme Cesca Rocha, Lydia Masako Ferreira

Published in: Obesity Surgery | Issue 1/2013

Login to get access

Abstract

Background

Abdominoplasty, the treatment for abdominal wall deformity stemming from weight loss after bariatric surgery, can cause postoperative anemia. Moreover, bariatric surgery has been associated with iron deficiency, which by itself can compromise erythropoiesis. The objective of this research is to describe the development of anemia after postbariatric abdominoplasty.

Methods

The study group consisted of 32 adult women who had received bariatric surgery. Treatment group included 20 patients who were undergoing postbariatric abdominoplasty. Control group included 12 patients waiting for abdominoplasty. Values of hemoglobin, reticulocytes, iron, ferritin, and the transferrin saturation were obtained on the evening before abdominoplasty and during the first, fourth, and eighth postoperative weeks. Hemoglobin was measured at 48 h.

Results

Mean hemoglobin levels for treatment group decreased from 12.98 to 10.8 g/dL after 48 h, increased on day 7 to 11.53 g/dL, but did not increase further after day 7. The reticulocyte number increased in the first week. Serum iron and transferrin saturation index fell during the first week and remained low. Ferritin levels increased non-significantly from 29.77 to 37.24 ng/mL at week 1, then fell until they were decreased (16.44 ng/mL) by day 56.

Conclusions

As expected, hemoglobin fell after abdominoplasty. However, after a one-third recovery of hemoglobin concentrations by week 1 postoperative, they failed to return to preoperative levels by the eighth week. Additionally, by the eighth postoperative week, 45 % of abdominoplasty patients had developed an iron deficiency and hemoglobin deficit that was higher than that of patients who maintained normal iron stocks.
Literature
1.
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
3.
go back to reference Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121:885–93.PubMedCrossRef Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121:885–93.PubMedCrossRef
4.
go back to reference Clegg A, Colquitt J, Sidhu M, et al. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord. 2003;27:1167–77.PubMedCrossRef Clegg A, Colquitt J, Sidhu M, et al. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord. 2003;27:1167–77.PubMedCrossRef
5.
go back to reference Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for body contour surgery. Clin Plast Surg. 2004;31:601–10.PubMedCrossRef Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for body contour surgery. Clin Plast Surg. 2004;31:601–10.PubMedCrossRef
6.
go back to reference Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83:403–9.PubMedCrossRef Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83:403–9.PubMedCrossRef
7.
go back to reference Marinella MA. Anemia following Roux-en-Y surgery for morbid obesity: a review. South Med J. 2008;101:1024–31.PubMedCrossRef Marinella MA. Anemia following Roux-en-Y surgery for morbid obesity: a review. South Med J. 2008;101:1024–31.PubMedCrossRef
8.
go back to reference Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.PubMedCrossRef Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.PubMedCrossRef
9.
go back to reference Poulose BK, Holzman MD, Zhu Y, et al. National variations in morbid obesity and bariatric surgery use. J Am Coll Surg. 2005;201:77–84.PubMedCrossRef Poulose BK, Holzman MD, Zhu Y, et al. National variations in morbid obesity and bariatric surgery use. J Am Coll Surg. 2005;201:77–84.PubMedCrossRef
10.
go back to reference Brolin RE, Gorman RC, Milgrim LM, et al. Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies. Int J Obes. 1991;15:661–7.PubMed Brolin RE, Gorman RC, Milgrim LM, et al. Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies. Int J Obes. 1991;15:661–7.PubMed
11.
go back to reference Song AY, Rubin JP, Thomas V, et al. Body image and quality of life in post massive weight loss body contouring patients. Obesity. 2006;14:1626–36.PubMedCrossRef Song AY, Rubin JP, Thomas V, et al. Body image and quality of life in post massive weight loss body contouring patients. Obesity. 2006;14:1626–36.PubMedCrossRef
12.
go back to reference Fraccalvieri M, Datta G, Bogetti P, et al. Abdominoplasty after weight loss in morbidly obese patients: a 4-year clinical experience. Obes Surg. 2007;17:1319–24.PubMedCrossRef Fraccalvieri M, Datta G, Bogetti P, et al. Abdominoplasty after weight loss in morbidly obese patients: a 4-year clinical experience. Obes Surg. 2007;17:1319–24.PubMedCrossRef
13.
go back to reference Bussolaro RA, Garcia EB, Barbosa MV, et al. Post-bariatric abdominoplasty: skin sensation evaluation. Obes Surg. 2010;20:855–60.PubMedCrossRef Bussolaro RA, Garcia EB, Barbosa MV, et al. Post-bariatric abdominoplasty: skin sensation evaluation. Obes Surg. 2010;20:855–60.PubMedCrossRef
14.
go back to reference Carson JL, Terrin ML, Magaziner J. Anemia and postoperative rehabilitation. Can J Anaesth. 2003;50:60S–4S.CrossRef Carson JL, Terrin ML, Magaziner J. Anemia and postoperative rehabilitation. Can J Anaesth. 2003;50:60S–4S.CrossRef
15.
go back to reference Wallach SG. Abdominal contour surgery for the massive weight loss patient: the fleur-de-lis approach. Aesth Surg J. 2005;25:454–65.CrossRef Wallach SG. Abdominal contour surgery for the massive weight loss patient: the fleur-de-lis approach. Aesth Surg J. 2005;25:454–65.CrossRef
16.
go back to reference Agha-Mohammadi S, Hurwitz DJ. Potential impacts of nutritional deficiency of postbariatric surgery patients in body contouring surgery. Plast Reconstr Surg. 2008;122:1901–14.PubMedCrossRef Agha-Mohammadi S, Hurwitz DJ. Potential impacts of nutritional deficiency of postbariatric surgery patients in body contouring surgery. Plast Reconstr Surg. 2008;122:1901–14.PubMedCrossRef
17.
go back to reference Bacuzzi A, Dionigi G, Piffaretti G, et al. Preoperative methods to improve erythropoiesis. Transplant Proc. 2011;43:324–6.PubMedCrossRef Bacuzzi A, Dionigi G, Piffaretti G, et al. Preoperative methods to improve erythropoiesis. Transplant Proc. 2011;43:324–6.PubMedCrossRef
18.
go back to reference Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008;36:2667–74.PubMedCrossRef Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008;36:2667–74.PubMedCrossRef
19.
go back to reference Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114:283–92.PubMedCrossRef Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114:283–92.PubMedCrossRef
20.
go back to reference Isbister JP, Shander A, Spahn DR, et al. Adverse blood transfusion outcomes: establishing causation. Transfus Med Rev. 2011;25:89–101.PubMedCrossRef Isbister JP, Shander A, Spahn DR, et al. Adverse blood transfusion outcomes: establishing causation. Transfus Med Rev. 2011;25:89–101.PubMedCrossRef
21.
go back to reference Conlon NP, Bale EP, Herbison GP, et al. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65 years old. Anesth Analg. 2008;106:1056–61.PubMedCrossRef Conlon NP, Bale EP, Herbison GP, et al. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65 years old. Anesth Analg. 2008;106:1056–61.PubMedCrossRef
22.
go back to reference Song AY, Jean RD, Hurwitz DJ, et al. A classification of contour deformities after bariatric weight loss: the Pittsburgh Rating Scale. Plast Reconstr Surg. 2005;116:1535–44.PubMedCrossRef Song AY, Jean RD, Hurwitz DJ, et al. A classification of contour deformities after bariatric weight loss: the Pittsburgh Rating Scale. Plast Reconstr Surg. 2005;116:1535–44.PubMedCrossRef
23.
go back to reference Cella D, Eton DT, Lai JS, et al. Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manage. 2002;24:547–61.PubMedCrossRef Cella D, Eton DT, Lai JS, et al. Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manage. 2002;24:547–61.PubMedCrossRef
24.
go back to reference Carless PA, Henry DA, Carson JL, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2010;10:CD002042.PubMed Carless PA, Henry DA, Carson JL, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2010;10:CD002042.PubMed
25.
go back to reference Costa LF, Landecker A, Manta AM. Optimizing body contour in massive weight loss patients: the modified vertical abdominoplasty. Plast Reconstr Surg. 2004;114:1917–23.PubMedCrossRef Costa LF, Landecker A, Manta AM. Optimizing body contour in massive weight loss patients: the modified vertical abdominoplasty. Plast Reconstr Surg. 2004;114:1917–23.PubMedCrossRef
26.
go back to reference Wallis JP, Wells AW, Whitehead S, et al. Recovery from post-operative anaemia. Transfus Med. 2005;15:413–8.PubMedCrossRef Wallis JP, Wells AW, Whitehead S, et al. Recovery from post-operative anaemia. Transfus Med. 2005;15:413–8.PubMedCrossRef
27.
go back to reference Turati C, Tursini P, Franzini C, et al. Saturazione della transferrina del siero e sovraccarico di ferro. Biochim Clin. 1997;21:10–5. Turati C, Tursini P, Franzini C, et al. Saturazione della transferrina del siero e sovraccarico di ferro. Biochim Clin. 1997;21:10–5.
28.
go back to reference Huynh H, Feldt LS. Conditions under which mean square ratios in repeated measurements designs have exact F-distributions. J Am Stat Assoc. 1970;65:1582–9.CrossRef Huynh H, Feldt LS. Conditions under which mean square ratios in repeated measurements designs have exact F-distributions. J Am Stat Assoc. 1970;65:1582–9.CrossRef
29.
go back to reference Ruz M, Carrasco F, Rojas P, et al. Iron absortion and iron status are reduced after Roux-en-Y gastric bypass. Am J Clin Nutr. 2009;90:527–32.PubMedCrossRef Ruz M, Carrasco F, Rojas P, et al. Iron absortion and iron status are reduced after Roux-en-Y gastric bypass. Am J Clin Nutr. 2009;90:527–32.PubMedCrossRef
30.
go back to reference Dalcanale L, Oliveira CPS, Faintuch J, et al. Long-term nutritional outcome after gastric bypass. Obes Surg. 2010;20:181–7.PubMedCrossRef Dalcanale L, Oliveira CPS, Faintuch J, et al. Long-term nutritional outcome after gastric bypass. Obes Surg. 2010;20:181–7.PubMedCrossRef
31.
go back to reference Brolin RE, Gorman JH, Gorman RC, et al. Prophylactic iron supplementation after Roux-en-Y gastric bypass: a prospective, double-blind, randomized study. Arch Surg. 1998;133:740–4.PubMedCrossRef Brolin RE, Gorman JH, Gorman RC, et al. Prophylactic iron supplementation after Roux-en-Y gastric bypass: a prospective, double-blind, randomized study. Arch Surg. 1998;133:740–4.PubMedCrossRef
32.
go back to reference Waseem T, Mogensen KM, Lautz DB, et al. Pathophysiology of obesity: why surgery remains the most effective treatment. Obes Surg. 2007;17:1389–98.PubMedCrossRef Waseem T, Mogensen KM, Lautz DB, et al. Pathophysiology of obesity: why surgery remains the most effective treatment. Obes Surg. 2007;17:1389–98.PubMedCrossRef
33.
go back to reference Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.PubMedCrossRef Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523–9.PubMedCrossRef
34.
go back to reference Davison SP, Clemens MW. Safety first: precautions for the massive weight loss patient. Clin Plast Surg. 2008;35:173–83.PubMedCrossRef Davison SP, Clemens MW. Safety first: precautions for the massive weight loss patient. Clin Plast Surg. 2008;35:173–83.PubMedCrossRef
35.
go back to reference Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc. 2004;104:1258–64.PubMedCrossRef Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc. 2004;104:1258–64.PubMedCrossRef
36.
go back to reference von Drygalski A, Andris DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract. 2009;24:217–26.CrossRef von Drygalski A, Andris DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract. 2009;24:217–26.CrossRef
37.
38.
39.
go back to reference Chan FK, Lanas A, Scheiman J, et al. Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet. 2010;376:173–9.PubMedCrossRef Chan FK, Lanas A, Scheiman J, et al. Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet. 2010;376:173–9.PubMedCrossRef
40.
go back to reference Goldstein JL, Chan FK, Lanas A, et al. Haemoglobin decreases in NSAID users over time: an analysis of two large outcome trials. Aliment Pharmacol Ther. 2011;34:808–16.PubMedCrossRef Goldstein JL, Chan FK, Lanas A, et al. Haemoglobin decreases in NSAID users over time: an analysis of two large outcome trials. Aliment Pharmacol Ther. 2011;34:808–16.PubMedCrossRef
41.
go back to reference Marín-Bertolín S, Valía Vera JC, González-Martínez R, et al. Blood loss and hematological recovery following reduction mammaplasty and dermolipectomy: a prospective study. Aesth Plast Surg. 1998;22:168–72.CrossRef Marín-Bertolín S, Valía Vera JC, González-Martínez R, et al. Blood loss and hematological recovery following reduction mammaplasty and dermolipectomy: a prospective study. Aesth Plast Surg. 1998;22:168–72.CrossRef
42.
go back to reference Grathwohl KW, Bruns BJ, LeBrun CJ, et al. Does hemodilution exist? Effects of saline infusion on hematologic parameters in euvolemic subjects. South Med J. 1996;89:51–5.PubMedCrossRef Grathwohl KW, Bruns BJ, LeBrun CJ, et al. Does hemodilution exist? Effects of saline infusion on hematologic parameters in euvolemic subjects. South Med J. 1996;89:51–5.PubMedCrossRef
43.
44.
go back to reference Modolin M, Cintra Jr W, Gobbi CI, et al. Circumferential abdominoplasty for sequential treatment after morbid obesity. Obes Surg. 2003;13:95–100.PubMedCrossRef Modolin M, Cintra Jr W, Gobbi CI, et al. Circumferential abdominoplasty for sequential treatment after morbid obesity. Obes Surg. 2003;13:95–100.PubMedCrossRef
45.
go back to reference Hillman RS. Characteristics of marrow production and reticulocyte maturation in normal man in response to anemia. J Clin Invest. 1969;48:443–53.PubMedCrossRef Hillman RS. Characteristics of marrow production and reticulocyte maturation in normal man in response to anemia. J Clin Invest. 1969;48:443–53.PubMedCrossRef
46.
go back to reference Biesma DH, Van de Wiel A, Beguin Y, et al. Post-operative erythropoiesis is limited by the inflammatory effect of surgery on iron metabolism. Eur J Clin Invest. 1995;25:383–9.PubMedCrossRef Biesma DH, Van de Wiel A, Beguin Y, et al. Post-operative erythropoiesis is limited by the inflammatory effect of surgery on iron metabolism. Eur J Clin Invest. 1995;25:383–9.PubMedCrossRef
47.
go back to reference van Iperen CE, Kraaijenhagen RJ, Biesma DH, et al. Iron metabolism and erythropoiesis after surgery. Br J Surg. 1998;85:41–5.PubMedCrossRef van Iperen CE, Kraaijenhagen RJ, Biesma DH, et al. Iron metabolism and erythropoiesis after surgery. Br J Surg. 1998;85:41–5.PubMedCrossRef
48.
go back to reference Killip S, Bennett JM, Chambers MD. Iron deficiency anemia. Am Fam Physician. 2007;75:671–8.PubMed Killip S, Bennett JM, Chambers MD. Iron deficiency anemia. Am Fam Physician. 2007;75:671–8.PubMed
49.
go back to reference Wish JB. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol. 2006;1:S4–8.PubMedCrossRef Wish JB. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol. 2006;1:S4–8.PubMedCrossRef
51.
52.
go back to reference García-Erce JA, Cuenca J, Martínez F, et al. Perioperative intravenous iron preserves iron stores and may hasten the recovery from post-operative anaemia after knee replacement surgery. Transfus Med. 2006;16:335–41.PubMedCrossRef García-Erce JA, Cuenca J, Martínez F, et al. Perioperative intravenous iron preserves iron stores and may hasten the recovery from post-operative anaemia after knee replacement surgery. Transfus Med. 2006;16:335–41.PubMedCrossRef
Metadata
Title
Hematological Variables and Iron Status in Abdominoplasty After Bariatric Surgery
Authors
Juan Carlos Montano-Pedroso
Elvio Bueno Garcia
Ivan Rene Viana Omonte
Mario Guilherme Cesca Rocha
Lydia Masako Ferreira
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 1/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0720-2

Other articles of this Issue 1/2013

Obesity Surgery 1/2013 Go to the issue