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Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study.
Surg Obes Relat Dis 2013 Nov-Dec; 9(6):969-74SO

Abstract

BACKGROUND

Iron deficiency (ID) is common after Roux-en-Y gastric bypass surgery (RYGB). Optimal iron management in this population is unclear. The objective of this study was to assess our management of RYGB patients with ID and anemia.

METHODS

Clinic visit records of RYGB patients with ID or anemia from January 1, 2008, to February 1, 2010 were evaluated. Demographic characteristics, postsurgery iron and anemia indices, and prescribed treatments were recorded. Three separate definitions for ID and anemia were used (standard textbook, ASBMS, and recent literature). An intravenous iron protocol was later implemented, and follow-up laboratory values were obtained.

RESULTS

A total of 125 with ID or anemia (89% female, 86% Caucasian), mean (SD) age 44.7 (8.6) years, and BMI 47.3 (10.8) kg/m(2) at time of RYGB, were included. Proportion of values meeting criteria for ID or anemia at first follow-up: standard textbook, hemoglobin (Hb, 35%), transferrin saturation (Tsat, 48%), ferritin (28%); ASBMS, ferritin (43%); recent literature, ferritin (58%), serum iron (21%). At mean follow-up of 45.7 (43) months, oral iron (n = 49) or intravenous iron (n = 4) had been prescribed for 53 (42.4%) patients, and 32 (25.6%) patients received multiple blood transfusions. Nine patients received intravenous iron using the new protocol (400-1400 mg), resulting in increases in Hb (1.8 g/dL; P<.05) and ferritin (31.8 ng/mL; P< .002).

CONCLUSION

Iron management was inadequate. Hematologic values often were deficient for sustained periods. Initially, few patients received intravenous iron after oral iron failure, many received no iron supplementation, and there was high use of blood transfusions. Subsequently, administration of intravenous iron was beneficial.

Authors+Show Affiliations

Albany College of Pharmacy and Health Sciences, Albany, New York. Electronic address: margaret.malone@acphs.edu.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

23499191

Citation

Malone, Margaret, et al. "Management of Iron Deficiency and Anemia After Roux-en-Y Gastric Bypass Surgery: an Observational Study." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 9, no. 6, 2013, pp. 969-74.
Malone M, Alger-Mayer S, Lindstrom J, et al. Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study. Surg Obes Relat Dis. 2013;9(6):969-74.
Malone, M., Alger-Mayer, S., Lindstrom, J., & Bailie, G. R. (2013). Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 9(6), pp. 969-74. doi:10.1016/j.soard.2013.01.019.
Malone M, et al. Management of Iron Deficiency and Anemia After Roux-en-Y Gastric Bypass Surgery: an Observational Study. Surg Obes Relat Dis. 2013;9(6):969-74. PubMed PMID: 23499191.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study. AU - Malone,Margaret, AU - Alger-Mayer,Sharon, AU - Lindstrom,Jennifer, AU - Bailie,George R, Y1 - 2013/02/13/ PY - 2012/09/27/received PY - 2013/01/08/revised PY - 2013/01/29/accepted PY - 2013/3/19/entrez PY - 2013/3/19/pubmed PY - 2014/9/5/medline KW - Anemia KW - Bariatric surgery KW - Intravenous iron KW - Iron deficiency KW - Roux-en-Y SP - 969 EP - 74 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 9 IS - 6 N2 - BACKGROUND: Iron deficiency (ID) is common after Roux-en-Y gastric bypass surgery (RYGB). Optimal iron management in this population is unclear. The objective of this study was to assess our management of RYGB patients with ID and anemia. METHODS: Clinic visit records of RYGB patients with ID or anemia from January 1, 2008, to February 1, 2010 were evaluated. Demographic characteristics, postsurgery iron and anemia indices, and prescribed treatments were recorded. Three separate definitions for ID and anemia were used (standard textbook, ASBMS, and recent literature). An intravenous iron protocol was later implemented, and follow-up laboratory values were obtained. RESULTS: A total of 125 with ID or anemia (89% female, 86% Caucasian), mean (SD) age 44.7 (8.6) years, and BMI 47.3 (10.8) kg/m(2) at time of RYGB, were included. Proportion of values meeting criteria for ID or anemia at first follow-up: standard textbook, hemoglobin (Hb, 35%), transferrin saturation (Tsat, 48%), ferritin (28%); ASBMS, ferritin (43%); recent literature, ferritin (58%), serum iron (21%). At mean follow-up of 45.7 (43) months, oral iron (n = 49) or intravenous iron (n = 4) had been prescribed for 53 (42.4%) patients, and 32 (25.6%) patients received multiple blood transfusions. Nine patients received intravenous iron using the new protocol (400-1400 mg), resulting in increases in Hb (1.8 g/dL; P<.05) and ferritin (31.8 ng/mL; P< .002). CONCLUSION: Iron management was inadequate. Hematologic values often were deficient for sustained periods. Initially, few patients received intravenous iron after oral iron failure, many received no iron supplementation, and there was high use of blood transfusions. Subsequently, administration of intravenous iron was beneficial. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/23499191/Management_of_iron_deficiency_and_anemia_after_Roux_en_Y_gastric_bypass_surgery:_an_observational_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(13)00039-7 DB - PRIME DP - Unbound Medicine ER -