Anemia and Related Deficiencies in Bariatric Surgery
Anemia is considered a global disease, with the incidence being especially very high in developing countries. After bariatric surgery, almost two-thirds of the population may be affected by anaemia with preoperative existing deficiency being an important
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Parimala Devi and Praveen Raj Palanivelu
34.1 Introduction Anemia is considered a global disease, with the incidence being especially very high in developing countries. After bariatric surgery, almost two-thirds of the population may be affected by anaemia with preoperative existing deficiency being an important contributing factor besides the consequences of bariatric surgery like pouch hypoacidity, bypassed small bowel, red meat intolerance etc. Anemia can be microcytic (which is usually due to iron deficiency) or macrocytic anaemia (which is usually due to vitamin B12 and/or folate deficiency). While iron, vitamin B12 and folate are the most commonly associated deficiencies, a significant number of anemias may be secondary to chronic inflammation and micronutrient deficiencies such as copper, zinc, vitamins A and E etc. The aim of this chapter is to understand the reasons for the development of anemia and the most commonly related deficiencies of iron, vitamin B12 and folic acid and its prevention/management in post bariatric surgical patients.
34.2 Importance of Iron, Folic Acid and B12 Iron is an essential mineral vital to make hemoglobin and myoglobin and plays a role in metabolic processes like oxygen transport, DNA synthesis and electron transport [1]. It is obtained as nonheme iron from vegetables and haeme iron from meat. Vitamin B12 is a key B vitamin important for proper brain development and deficiency causes central nervous system development disorders and dementia [2]. Folate is a water soluble B vitamin (also known as vitamin B9) essential for amino P. Devi, MSc (*) • P.R. Palanivelu, MS, DNB, DNB (SGE), FALS, FMAS Bariatric Division, Upper Gastrointestinal Surgery and Minimal Access Surgery Unit, GEM Hospital and Research Centre, Coimbatore, India e-mail: [email protected]; [email protected] © Springer Nature Singapore Pte Ltd. 2017 P.R. Palanivelu et al. (eds.), Bariatric Surgical Practice Guide, DOI 10.1007/978-981-10-2705-5_34
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acid metabolism, DNA synthesis, repair and methylation [3]. Folate includes endogenous food folate and its synthetic form folic acid [4]. Bioavailability of folic acid is 70 % higher than the natural folate present in the foods [5].
34.3 Etiology of Post-bariatric Surgery Anemia Several factors have been implicated in the occurrence of anaemia after bariatric surgery. These include (1) preoperative existing deficiency (2) malabsorption due to the surgical procedure (3) inadequate dietary intake in the post-operative period (4) altered drug bioavailability (5) reduced hematopoiesis (6) inflammation related to obesity (increased hepcidin) (7) altered absorption and metabolism of other nutrients. Premenopausal women have higher risk of post-operative development of anemia [6, 7]. The most common non-malabsorptive types of anemia were inflammation and dysfunctional uterine bleeding [8]. The incidences have also been less common with better follow up profile [9]. Of all of the above factors preoperative existing defic
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