title: Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study.
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).
  
  
  CONCLUSIONS
  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.affiliation: Albany College of Pharmacy and Health Sciences, Albany, New York. Electronic address: margaret.malone@acphs.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Malone
authors.forename: Sharon
authors.initials: S
authors.lastname: Alger-Mayer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lindstrom
authors.forename: George R
authors.initials: GR
authors.lastname: Bailie
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D001774:Blood Chemical Analysis; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007262:Infusions, Intravenous; D058085:Iron Compounds / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D058085:Iron Compounds; D005293:Ferritins
keywords: Anemia; Bariatric surgery; Intravenous iron; Iron deficiency; Roux-en-Y