Love Aileen L, Billett Henny H
Department of Medicine, Weill Cornell Medical Center, New York, New York, USA.
Am J Hematol. 2008 May;83(5):403-9. doi: 10.1002/ajh.21106.
Morbid obesity is a health problem that has been shown to be refractory to diet, exercise, and medical treatment. Surgeries designed to promote weight loss, termed bariatric surgery and typically involving a gastric bypass procedure, have recently been implemented to treat obesity with high success rates. However, long-term sequelae can result in micronutrient deficiencies. This review will focus on iron deficiency and its association with obesity and bariatric surgery. Iron deficiency develops after gastric bypass for several reasons including intolerance for red meat, diminished gastric acid secretion, and exclusion of the duodenum from the alimentary tract. Menstruating women, pregnant women, and adolescents may be particularly predisposed toward developing iron deficiency and microcytic anemias after bypass surgery. Preoperative assessment of patients should include a complete hematological work-up, including measurement of iron stores. Postoperatively, oral iron prophylaxis and vitamin C in addition to a multivitamin should be prescribed for bypass patients, especially for vulnerable populations. Once iron deficiency has developed, it may prove refractory to oral treatment, and require parenteral iron, blood transfusions, or surgical interventions. Bariatric surgery patients require lifelong follow-up of hematological and iron parameters since iron deficiency and anemia may develop years after surgery.
病态肥胖是一个已被证明对饮食、运动和药物治疗均难有疗效的健康问题。旨在促进体重减轻的手术，即减肥手术，通常涉及胃旁路手术，最近已被用于治疗肥胖症，成功率很高。然而，长期后遗症可能导致微量营养素缺乏。本综述将聚焦于缺铁及其与肥胖症和减肥手术的关联。胃旁路手术后缺铁的发生有多种原因，包括对红肉不耐受、胃酸分泌减少以及十二指肠被排除在消化道之外。月经女性、孕妇和青少年在旁路手术后可能特别容易发生缺铁和小细胞性贫血。对患者的术前评估应包括完整的血液学检查，包括铁储备的测定。术后，应给旁路手术患者开口服铁剂、维生素C以及复合维生素，尤其是针对易感人群。一旦发生缺铁，口服治疗可能无效，需要注射铁剂、输血或手术干预。减肥手术患者需要对血液学和铁参数进行终身随访，因为缺铁和贫血可能在手术后数年才会出现。
