The incidence of iron deficiency anemia post-Roux-en-Y gastric bypass and sleeve gastrectomy: a systematic review

Enani, Ghada; Bilgiç, Elif; Lebedeva, E. V.; Delisle, Megan; Vergis, Ashley; Hardy, Krista

doi:10.1007/s00464-019-07092-3

Cited by 52 publications

(30 citation statements)

References 40 publications

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“…There was a significant improvement in iron deficiency in men over this time; however, tendencies towards abrogation of iron deficiency in women and according to each type of surgery remained statistically non-significant. A recent meta-analysis of twenty studies between 2000 and 2015 reported similar absolute rates of iron deficiency when comparing procedures, with a frequency of 22.5% post-GB and 12.4% post-SG, but with an increased risk of iron deficiency after GB but not SG, from a baseline of 14.7% and 36.6%, respectively [35]. This worsening of iron status after GB has been noted elsewhere [20] and is likely due to bypassing of the stomach and duodenum, precluding efficient iron absorption [24].…”

Section: Discussionmentioning

confidence: 97%

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

et al. 2020

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Purpose Bariatric surgery is associated with deficiencies of vitamins and minerals, and patients are routinely advised supplements postoperatively. We studied prevalence of vitamin B 12 , folate and iron deficiencies and anaemia before and after bariatric surgery over 4 years of follow-up. Materials and Methods We performed a retrospective cohort analysis of 353 people with obesity, including 257 (72.8%) women, who underwent gastric bypass (252, 71.4%) or sleeve gastrectomy (101, 28.6%) at our National Health Service bariatric centre in Northwest England. Results At baseline, mean (standard error) age was 46.0 (0.6) years, body mass index 53.1 (0.4) kg/m 2 , serum vitamin B 12 400.2 (16.4) pg/L, folate 7.7 (0.2) μg/L, iron 12.0 (0.3) μmol/L, ferritin 118.3 (8.4) μg/L and haemoglobin 137.9 (0.8) g/L. Frequency of low vitamin B 12 levels reduced from 7.5% preoperatively to 2.3% at 48 months (P < 0.038). Mean folate levels increased from baseline to 48 months by 5.3 μg/L (P < 0.001) but frequency of low folate levels increased from 4.7% preoperatively to 10.3% (P < 0.048). Ferritin levels increased from baseline to 48 months by 51.3 μg/L (P < 0.009). Frequency of low ferritin levels was greater in women (39.1%) than in men (8.9%) at baseline (P < 0.001) and throughout the study period. Haemoglobin was low in 4.6% of all patients at baseline with no significant change over the study period. Conclusion There were notable rates of haematinic insufficiencies in bariatric surgical candidates preoperatively. Our study lends further support to regular supplementation with vitamin B 12 , folic acid, and iron in people undergoing bariatric surgery.

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Section: Discussionmentioning

confidence: 97%

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

et al. 2020

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“…This may represent a confounder as this factor has been reported in a recent systematic review to be predictive of iron-deficiency anemia. 10 However, the effect of this is probably small as there was no significant age difference between the 2 patient groups in this data set.…”

Section: Limitationsmentioning

confidence: 78%

“…Interestingly, body mass index was not a contributing factor. 10 Given the importance of this issue, there has been increased focus on adequate iron supplementation before and after bariatric surgery. This includes the establishment of minimum preoperative ferritin levels.…”

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confidence: 99%

Iron deficiency in bariatric surgery patients: a single-centre experience over 5 years

Lowry

Hardy

Vergis

2020

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Iron deficiency in bariatric surgery patients: a single-centre experience over 5 years Background: As the prevalence of obesity has increased, so too has the demand for bariatric surgery. This study aimed to determine the incidence of postoperative iron deficiency and anemia and the impact of an increased preoperative ferritin target on postoperative outcomes. Methods: Patients undergoing bariatric surgery in Winnipeg from 2010 to 2014 were included in the analysis. Data capture included age, sex and date of surgery and iron, ferritin and hemoglobin levels before surgery and 12 months postoperatively. Before 2014, there was no protocol for preoperative iron supplementation at our centre; in 2014, a more aggressive preoperative iron supplementation program was introduced to target a minimum preoperative ferritin level of 50 mg/L. Data were analyzed using unpaired t tests, paired t tests and χ 2 tests. Results: A total of 399 patients were considered; 288 were included in the analysis. The incidence of iron and ferritin deficiency and anemia at 12 months postoperatively was 14.6%, 9.3% and 15.0%, respectively. In patients who underwent surgery before 2014, the 12-month postoperative levels of iron and ferritin were 12.9 mmol/L and 64.0 mg/L, respectively; patients who underwent surgery in 2014 had levels of 18.3 mmol/L and 124.0 mg/L, respectively (all p = 0.001). The 12-month postoperative hemoglobin levels did not significantly differ between the 2 groups. Conclusion: Bariatric surgery performed with more aggressive preoperative iron supplementation is associated with increased iron and ferritin levels at 1 year postoperatively. As this improves overall clinical outcomes by avoiding iron deficiency and anemia, a minimum preoperative ferritin target should be implemented in metabolic and bariatric surgery programs. Contexte : L'augmentation de la prévalence de l'obésité s'est accompagnée d'un accroissement de la demande de chirurgie bariatrique. La présente étude visait à déterminer l'incidence de la carence en fer et de l'anémie postopératoires ainsi que les conséquences de la hausse du taux cible de ferritine avant l'intervention sur les issues postopératoires. Méthodes : L'analyse a porté sur des patients ayant subi une chirurgie bariatrique à Winnipeg entre 2010 et 2014. Les données recueillies faisaient état de l'âge, du sexe et de la date d'opération des patients, ainsi que de leurs taux de fer, de ferritine et d'hémoglobine avant la chirurgie et 12 mois après celle-ci. Avant 2014, notre centre n'avait pas de protocole de supplémentation préopératoire en fer; en 2014, il a instauré un programme de supplémentation rigoureux visant un taux préopératoire de ferritine d'au moins 50 mg/L. L'analyse des données a été faite au moyen de tests t non appariés, de tests t appariés et de tests χ 2. Résultats : Au total, les cas de 399 patients ont été envisagés pour l'analyse, et 288 ont été retenus. L'incidence de la carence en fer, celle de la carence en ferritine et celle de l'anémie 12 mois après la chirurgie étaien...

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“…In a systematic review on iron deficiency after RYGB and sleeve gastrectomy with an average follow-up time of 27.8 months, the overall incidence of iron deficiency anaemia were 14.8% post-RYGB, and iron deficiency occurred in 22.5% [40]. Only two of the studies included in the review reported on intravenous iron treatment.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Iron Treatment in the Prevention of Iron Deficiency and Anaemia After Roux-en-Y Gastric Bypass

et al. 2020

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Background Iron absorption is disturbed after Roux-en-Y gastric bypass (RYGB) and iron deficiency with or without anaemia affects almost half of all patients. Intravenous iron is an option when per oral iron is insufficient or not tolerated. This study explores whether routinely offering intravenous iron treatment when iron stores are empty can prevent anaemia and iron deficiency after RYGB. Methods This is a study of prospectively registered data on clinical information, haematological tests and intravenous iron treatment from 644 RYGB patients who underwent surgery between 2004 and 2013, postoperatively followed more than 5 years. Intravenous iron treatment was offered to patients with ferritin ≤ 15 μg/L. Results Clinical information was available for all patients at baseline and for 553/644 patients at 5 years; laboratory results were available for 540/644 patients at baseline and 411/644 patients after 5 years. The mean age was 39.8 (± 9.7) years. Overall, 187/483 (38.7%) women and 9/161 (5.6%) men were given intravenous iron treatment in the observation period. From baseline to 5 years, mean haemoglobin decreased by 0.3 g/dL in both men and women. Anaemia occurred in 18/311 (5.8%) women and 9/100 (9%) men at 5 years. Depleted iron stores (ferritin ≤ 15 μg/L) were seen among 44/323(13.6%) women and 3/102 (2.9%) men, and low iron stores (ferritin 16-50 μg/L) occurred in 144/326 (44.6%) women and 38/102 (37.3%) men 5 years after RYGB. Conclusion By routinely offering intravenous iron treatment to patients with depleted iron stores after RYGB, haemoglobin levels were preserved. Half of the patients experienced low or depleted iron stores at 5 years.

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The incidence of iron deficiency anemia post-Roux-en-Y gastric bypass and sleeve gastrectomy: a systematic review

Cited by 52 publications

References 40 publications

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

Iron deficiency in bariatric surgery patients: a single-centre experience over 5 years

Intravenous Iron Treatment in the Prevention of Iron Deficiency and Anaemia After Roux-en-Y Gastric Bypass

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