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

Jorunn Sandvik,Torstein Hole,Bård Eirik Kulseng,Arne Wibe,Christian A Klöckner

doi:10.1007/s11695-020-04396-5

Abstract

BackgroundIron 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.MethodsThis 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.ResultsClinical 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.ConclusionBy 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.

Highlights

Introduction30% of the 635,000 patients worldwide undergoing a bariatric procedure each year get Roux-en-Y gastric bypass (RYGB) [2]
Roux-en-Y gastric bypass (RYGB) has been a common bariatric procedure for more than 50 years [1], and more than30% of the 635,000 patients worldwide undergoing a bariatric procedure each year get RYGB [2]
The aim of this study was to explore whether routinely offering intravenous iron treatment to patients with depleted iron stores after RYGB, regardless of haemoglobin levels, preserved iron stores and prevented iron deficiency anaemia 5 years after surgery

Summary

Introduction

30% of the 635,000 patients worldwide undergoing a bariatric procedure each year get RYGB [2] This procedure implies that the food bolus bypasses the main part of the stomach, the duodenum and the proximal jejunum, and instead passes. OBES SURG (2020) 30:1745–1752 through an alimentary limb of 1 m or more before the food blends with bile and pancreatic enzymes The aim of this procedure is to reduce capacity for food intake and absorption of energy from the food. Anaemia has been reported in up to half of the patients 5 years after RYGB, and iron deficiency is even more frequent, due to a combination of lack of intake of iron-rich food and lack of iron absorption [6,7,8]. Roux-en-Y gastric bypass (RYGB) and iron deficiency with or without anaemia affects almost half of all patients.

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