title: Incidence, treatment, and outcomes of iron deficiency after laparoscopic Roux-en-Y gastric bypass: a 10-year analysis.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass (LRYGB) can lead to iron malabsorption through exclusion of the duodenum and proximal jejunum, decreased gastric acidity, and modified diet. Intravenous (IV) iron is a treatment for severe iron deficiency, but the incidence of iron deficiency and the frequency of treatment with IV iron after LRYGB are largely unknown. Our objective was to determine the incidence of iron deficiency and the frequency of IV iron administration after LRYGB.
  
  
  METHODS
  After obtaining IRB approval, the medical records of patients who underwent LRYGB from September 2001 to December 2011 were retrospectively reviewed. Inclusion criteria consisted of determination of at least 1 ferritin value after surgery. Patients were grouped by level of iron deficiency. Patients with at least 1 ferritin <50 ng/mL were considered iron deficient. Statistical analysis included ANOVA.
  
  
  RESULTS
  There were 959 patients included; 84.9% were female. Mean age was 43.8 years, and preoperative body mass index was 47.4 kg/m(2). Four hundred ninety-two (51.3%) patients were iron deficient. Of these, 40.9% were severely iron deficient, with a ferritin <30 ng/mL. Intravenous iron was required by 6.7%. After IV iron therapy, 53% had improvement in hemoglobin and ferritin values, and 39% had improvement in ferritin values only.
  
  
  CONCLUSIONS
  Given the incidence of iron deficiency after LRYGB observed in our series, patients should have iron status monitored carefully by all providers and be appropriately referred for treatment. Female patients should be counseled that there is a 50% chance they will become iron deficient after LRYGB.
authors: Minimally Invasive Bariatric Surgery and Advanced Laparoscopy Fellowship, La Crosse, WI.
authors: Kosisochi M
authors: KM
authors: Obinwanne
authors: Department of Research, Gundersen Medical Foundation, La Crosse, WI.
authors: Kyla A
authors: KA
authors: Fredrickson
authors: Department of Research, Gundersen Medical Foundation, La Crosse, WI.
authors: Michelle A
authors: MA
authors: Mathiason
authors: Department of Research, Gundersen Medical Foundation, La Crosse, WI.
authors: Kara J
authors: KJ
authors: Kallies
authors: Department of Hematology, Gundersen Health System, La Crosse, WI.
authors: John P
authors: JP
authors: Farnen
authors: Department of General and Vascular Surgery, Gundersen Health System, La Crosse, WI. Electronic address: snkothar@gundersenhealth.org.
authors: Shanu N
authors: SN
authors: Kothari
mesh_terms: D000284:Administration, Oral; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D058085:Iron Compounds / Q000008:administration & dosage*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D058085:Iron Compounds
keywords: BMI; IV; LRYGB; body mass index; intravenous; laparoscopic Roux-en-Y gastric bypass