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Nutrición Hospitalaria

On-line version ISSN 1699-5198Print version ISSN 0212-1611

Abstract

MAGALI SANCHEZ, Angela María; PAMPILLON, Natalia; ABAURRE, Mariela  and  OMELANCZUK, Pablo. Pre-operative iron deficiency in bariatric surgery: diagnosis and treatment. Nutr. Hosp. [online]. 2015, vol.32, n.1, pp.75-79. ISSN 1699-5198.  http://dx.doi.org/10.3305/nh.2015.32.1.8871.

Introduction: chronic inflammation induced by obesity alters iron homeostasis leading to mild /moderate iron deficiency and anaemia. Between 14% and 43% of patients may suffer from iron deficiency without anaemia before surgery. The management of peri-operative iron deficiency improves patient outcome and quality of life. Under certain circumstances intravenous (IV) iron must be considered. IV iron (which may avoid iron blockage in enterocytes and macrophages) has turned out to be a safe and efficient alternative. Objetives:1) To assess the prevalence of iron deficiency in morbidly obese patients candidates for bariatric surgery. 2) Assess whether supplementation of parenteral iron in iron-deficient patients is effective in preventing the decrease in hematocrit after surgery. Materials and methods: prospective, observational study which included 89 morbidly obese patients who underwent bariatric surgery. The population was divided according to whether or not patients had pre-op iron deficiency, and post-op evolution was analyzed. Iron-deficient patients were supplemented with 500 mg of intravenous (IV) carboximaltose and were evaluated post-op. Results: twenty-three patients (25.8%) presented preop iron deficiency pre-operatively while six (6.74%) had anemia. 74.2% (66 patients) had no iron deficiency. The group without iron deficiency at one month of surgery had the following laboratory values: Hematocrit: 41.30% ± 3.77; hemoglobin: 13.64 g/l ± 1.25 and transferrin saturation: 30.55 %. The patients with pre-op iron deficiency had the following values: Hematocrit: 40.40% ± 3.03; hemoglobin: 13.40 g/l ± 1.07; transferrin saturation: 15.50% ± 4.18, and ferritin: 87.10 ng/ml ± 81.23. Post-op hematocrit reduction was 38.40% ± 3.17 (p: 0.034). In iron-deficient patients without IV iron supplementation (n=15), hematocrit and hemoglobin were 41.2% ± 2.5 and 13.7 g/l ± 0.9 respectively with post-op reduction (37.5% ± 3.4 and 12.3 g/l p < 0.05). IV iron supplementation in iron-deficient patients (n = 9) increased hemoglobin (13.5 g/l ± 0.7), compared with the pre-op (12.8 g/l ± 1.2; p: 0.05), as well as transferrin saturation and ferritin. One month after surgery there were no significant changes in hematocrit (pre-op: 39%, post-op: 40% p: > 0.05). Discussion: 1) Almost 26% of patients present pre-op iron deficiency. 2) Treatment with IV iron seems to be efficient to prevent hematocrit reduction and to improve iron metabolism in pre-op iron-deficient patients. In patients without iron deficiency, hematocrit and iron metabolism remain normal one month after surgery without the need for iron supplementation.

Keywords : Morbid obesity; Bariatric surgery; Iron deficiency; Anemia; Intravenous iron.

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