Varma Seema, Baz Walid, Badine Edgard, Nakhl Fadi, McMullen Heather, Nicastro Jeffrey, Forte Frank, Terjanian Terenig, Dai Qun
Department of Medicine, Division of Hematology and Oncology, Sanford R Nalitt Institute for Cancer and Blood Related Diseases, Staten Island University Hospital, Staten Island, New York, USA.
Surg Obes Relat Dis. 2008 Nov-Dec;4(6):715-9. doi: 10.1016/j.soard.2008.04.015. Epub 2008 Jun 30.
Malabsorptive bariatric procedures such as Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch expose the patient to malnutrition and commonly cause iron deficiency. The optimal replacement and monitoring method remain undetermined. To identify high-risk patients who might need intravenous iron supplementation after bariatric surgery, we evaluated bariatric surgery patients who received parenteral iron at a university hospital-affiliated hematology center.
We performed a retrospective analysis and reviewed the records of 165 patients who had received parenteral iron from May 2004 to June 2007. Of the 165 patients, 42 bariatric surgery patients were identified. The type of bariatric procedure and menstrual status of the patients were compared.
The average patient age was 40 years. Of the 42 patients, 2 were men and 40 were women. Of the 40 women, 32 were premenopausal and 8 were postmenopausal. The patients in the biliopancreatic diversion/duodenal switch group had a significantly lower hemoglobin at presentation (P = .02), relatively lower ferritin levels, and required more additional parenteral iron treatment after the initial resolution of anemia (P = .001). The premenopausal women required earlier parenteral replacement (P = .008) and were at a greater risk of anemia-related hospitalization (P = .00033).
The available published studies lack any data regarding parenteral iron replacement needs after bariatric surgery. Our results have identified the need for long-term parenteral iron replacement therapy after malabsorptive bariatric procedures, especially in premenopausal women. Patients who do not respond to oral iron therapy should be referred early for parenteral iron replacement therapy to prevent anemia-related complications and to maintain patients' quality of life. Iron monitoring should continue indefinitely even after the initial repletion of iron stores and the resolution of anemia.
诸如Roux-en-Y胃旁路术和胆胰分流/十二指肠转位术等吸收不良型减重手术会使患者面临营养不良的风险，且通常会导致缺铁。最佳的补铁及监测方法仍未确定。为了识别减重手术后可能需要静脉补铁的高危患者，我们对在一家大学附属医院血液科接受胃肠外铁剂治疗的减重手术患者进行了评估。
我们进行了一项回顾性分析，并查阅了2004年5月至2007年6月期间接受胃肠外铁剂治疗的165例患者的记录。在这165例患者中，识别出42例减重手术患者。比较了患者的减重手术类型和月经状况。
患者的平均年龄为40岁。在这42例患者中，2例为男性，40例为女性。在40例女性中，32例为绝经前女性，8例为绝经后女性。胆胰分流/十二指肠转位术组的患者在就诊时血红蛋白水平显著较低（P = 0.02），铁蛋白水平相对较低，并且在最初贫血症状缓解后需要更多的额外胃肠外铁剂治疗（P = 0.001）。绝经前女性需要更早进行胃肠外补铁（P = 0.008），并且因贫血相关原因住院的风险更高（P = 0.00033）。
现有的已发表研究缺乏关于减重手术后胃肠外铁剂补充需求的任何数据。我们的结果表明，在吸收不良型减重手术后需要长期进行胃肠外铁剂替代治疗，尤其是在绝经前女性中。对口服铁剂治疗无反应的患者应尽早转诊接受胃肠外铁剂替代治疗，以预防贫血相关并发症并维持患者的生活质量。即使在最初补充铁储备和贫血症状缓解后，也应无限期持续进行铁监测。
