This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by von Drygalski, A. Articles by Andris, D. A. Search for Related Content PubMed PubMed Citation Articles by von Drygalski, A. Articles by Andris, D. A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB IRON Medline Plus Health Information Weight Loss Surgery Social Bookmarking                         What's this?

Anemia After Bariatric Surgery: More Than Just Iron Deficiency

From the ¹ Department of Medicine, Division of Hematology/Oncology, University of California at San Diego, San Diego, California; and the ² Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.

Correspondence: Address correspondence to: Annette von Drygalski, MD, PharmD, VA San Diego Healthcare System, La Jolla Medical Center, 3350 La Jolla Village Dr, 111E, San Diego, CA 92161; e-mail: avondrygalski{at}ucsd.edu.

Bariatric surgery for morbid obesity is rapidly gaining popularity. Restrictive and/or malabsorptive surgical interventions result in dramatic weight loss with significantly decreased obesity-related morbidity and mortality. Anemia, which may affect as many as two-thirds of these patients, is of concern and generally thought to be caused by iron deficiency. Although iron deficiency in this population may be frequent given pouch hypoacidity, defunctionalized small bowel, and red meat intolerance, it may not account for all anemias seen. First, there is increasing evidence that obesity creates a state of chronic inflammation. Both iron deficiency anemia and anemia of chronic inflammation present with low serum iron levels. Most studies reporting anemia after bariatric surgery lack serum ferritin determinations so that the relative contribution of inflammation to anemia cannot be assessed. Second, a significant number of anemias after bariatric surgery remain unexplained and may be attributable to less frequently seen micronutrient deficiencies such as copper, fatsoluble vitamins A and E, or an imbalance in zinc intake. Third, although deficiencies of folate and vitamin B₁₂ are infrequent, study observation periods may be too short to detect anemia attributable to vitamin B₁₂ deficiency because vitamin B₁₂ storage depletion takes many years. This review is intended to increase awareness of the mechanisms of anemia above and beyond iron deficiency in the bariatric patient and provide healthcare providers with tools for a more thoughtful approach to anemia in this patient population.

Key Words: bariatric surgery • anemia • anemia, iron deficiency • obesity • inflammation • micronutrients

Nutrition in Clinical Practice, Vol. 24, No. 2, 217-226 (2009)
DOI: 10.1177/0884533609332174


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?