Persistent anemia after Roux-en-Y gastric bypass

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2007-03, Vol.23 (3), p.277-280
• Main Authors: Mizón, Claudio, M.D, Ruz, Manuel, Ph.D, Csendes, Attila, M.D, Carrasco, Fernando, M.D, Rebolledo, Annabella, M.Sc, Codoceo, Juana, M.T, Inostroza, Jorge, M.T, Papapietro, Karin, M.D, Pizarro, Fernando, M.T, Olivares, Manuel, M.D
• Format: Article
• Language: English
• Subjects: Absorption; Adult; Anemia; Anemia, Iron-Deficiency - drug therapy; Anemia, Iron-Deficiency - epidemiology; Anemia, Iron-Deficiency - etiology; Ascorbic Acid - pharmacokinetics; Ascorbic Acid - therapeutic use; bariatric surgery; Biological and medical sciences; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastric bypass; Gastric Bypass - adverse effects; Gastroenterology and Hepatology; Gastrointestinal surgery; Humans; Intestinal Absorption - drug effects; Iron; iron deficiency anemia; Morbid obesity; morbidity; Mortality; Obesity; Obesity, Morbid - blood; Obesity, Morbid - surgery; overweight; postoperative complications; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Weight control; women
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2007.01.008

Abstract Objective We report the case of a 42-y-old morbidly obese woman who presented persistent anemia as result of Roux-en-Y gastric bypass. Methods The surgical procedure conducted in 1999 consisted of horizontal gastroplasty with truncular vagotomy, Roux-en-Y gastrojejunal anastomosis with an alimentary limb of 60 cm, and cholecystectomy. In 2000 a second surgery (subtotal gastrectomy, i.e., 90%, with a 50-mL gastric pouch) was performed because of failed gastroplasty. Anemia was detected approximately 1 y after the second surgery. This condition worsened significantly after an abdominal lipectomy performed in 2001. Since then, different oral iron compounds were used for treatment, but with unsatisfactory results. The subject was anemic for 4 y. Results The condition was corrected only after intravenous iron administration. Iron absorptions from 3 mg of iron as ferrous ascorbate and from a standardized diet that also contained 3 mg of iron were 48.4% and 39.9%, respectively. Conclusion Iron absorption tests provided evidence that the reduction of intestinal iron absorption capacity was the most probable cause of the persistent anemia.