title: Anemia and the Need for Intravenous Iron Infusion after Roux-en-Y Gastric Bypass.
abstract: The frequency of anemia, iron deficiency, and the long-term need for IV iron following Roux-en-y gastric bypass (RYGB) surgery has not been well characterized. Three-hundred and nineteen out of 904 consecutive subjects who underwent RYGB at Penn State Hershey Medical Center from 1999 to 2006 met the inclusion criteria for a preoperative complete blood count (CBC) and at least one CBC >6 months following surgery. Cumulative incidence of anemia 7 years post procedure was 58%. Menstruation status and presence of preoperative anemia were predictive of anemia by univariate analysis and multivariable Cox regression (P = 0.0014 and 0.044, respectively). Twenty-seven subjects, primarily premenopausal women, representing 8.5% of the cohort and 22% of the 122 anemic subjects, needed intravenous (IV) iron a mean of 51 months postoperatively for anemia unresponsive or refractory to oral iron. The risk for development of anemia necessitating IV iron therapy following RYGB is highest in menstruating women and continues to increase for many years, even in post-menopausal women. Well-designed prospective studies are needed to identify the incidence of iron deficiency anemia and the patient populations at increased risk for requiring IV iron replacement after RYGB surgery.
authors.affiliation: LVH-M Cancer Center, Bethlehem, Pennsylvania, PA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Kotkiewicz
authors.affiliation: Department of Pathology, Division of Clinical Pathology, Hershey, PA, USA.
authors.forename: Keri
authors.initials: K
authors.lastname: Donaldson
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hershey, PA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Dye
authors.affiliation: Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Hershey, PA, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Rogers
authors.affiliation: Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Mauger
authors.affiliation: Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Lan
authors.initials: L
authors.lastname: Kong
authors.affiliation: Division of Hematology/Oncology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: M Elaine
authors.initials: ME
authors.lastname: Eyster
keywords: anemia; bariatric surgery; intravenous iron replacement; iron deficiency; parenteral iron