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KMID : 1033120140030020033
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대한비만대사외과학회지
2014 Volume.3 No. 2 p.33 ~ p.37
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Iron Deficiency Anemia after Bariatric Surgery
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Seo Kyung-Won
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Abstract
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As obesity and bariatric surgery rates continue to increase, anemia will become noticeable problems for this patient population. Preoperative assessment of patients should include a complete hematological work-up, including measurement of iron stores, vitamin B12, and folate. Iron deficiency after bariatric surgery results from both malabsorption and maldigestion of dietary iron. Bariatric bypass surgeries, namely Roux-en-Y gastric bypass (RYGB) and Biliopancreatic diversion-duodenal switch (BPD-DS), exacerbate this problem. Iron deficiency is identified in preoperative and postoperative bariatric patients, particularly in premenstrual women. Decreased acid production in the small gastric pouch impedes the solubilization of ferric iron and ultimately absorption of the reduced form, ferrous iron, in the duodenum. Postoperative changes in eating habits and food preferences may also contribute to development of iron deficiency after RYGB. Menstruating women are at high risk for iron deficiency and anemia after bypass surgery. Postoperatively, oral iron supplementation in addition to a multivitamin should be prescribed for RYGB patients. Pregnant women who have undergone bariatric surgery may also be at high risk of developing iron deficiency, and these patients may require aggressive oral iron supplementation. Once iron deficiency has developed, however, it may show refractory to treatment. In some cases, intravenous iron, blood transfusions, and surgical interventions to stop sources of bleeding may be required. Bariatric surgery patients call for lifelong follow-up of hematological and iron parameters, since iron deficiency and anemia may develop years after surgery.
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KEYWORD
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Obesity, Bariatric surgery, Iron deficiency anemia
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