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. 1985 Feb;201(2):186–193. doi: 10.1097/00000658-198502000-00009

Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity.

J F Amaral, W R Thompson, M D Caldwell, H F Martin, H T Randall
PMCID: PMC1250639  PMID: 3970598

Abstract

To evaluate the long-term frequency and severity of anemia and selected vitamin and mineral deficiencies after gastric exclusion surgery for morbid obesity, the authors prospectively examined hematologic and nutritional parameters in 150 consecutive patients. These patients underwent a standardized gastric exclusion procedure during a six-year period (1976-1982) and were closely followed for up to seven years (mean, 33.2 months). Anemia developed in 36.8% of the population at a mean time from operation of 20 months. It was more frequent in women than in men (p less than 0.01), and it required transfusions in 3.5% of the population. A low serum iron concentration developed in 48.6%, iron deficiency in 47.2%, a low serum vitamin B12 concentration in 70.1%, vitamin B12 deficiency in 39.6%, and RBC folate deficiency in 18% of the population. Both iron and folate deficiencies responded to oral replacement. As a result of the high frequency and severity of anemia and nutritional deficiencies noted, all gastric exclusion patients should, as a minimum, be placed on oral multivitamin preparations containing iron, folate and vitamin B12. In addition, it is imperative that these patients be followed closely for the remainder of their lives with appropriate studies and replacement as necessary.

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Selected References

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  1. Amaral J. F., Thompson W. R., Caldwell M. D., Martin H. F., Randall H. T. Prospective metabolic evaluation of 150 consecutive patients who underwent gastric exclusion. Am J Surg. 1984 Apr;147(4):468–476. doi: 10.1016/0002-9610(84)90007-2. [DOI] [PubMed] [Google Scholar]
  2. BAINTON D. F., FINCH C. A. THE DIAGNOSIS OF IRON DEFICIENCY ANEMIA. Am J Med. 1964 Jul;37:62–70. doi: 10.1016/0002-9343(64)90212-8. [DOI] [PubMed] [Google Scholar]
  3. BAIRD I. M., BLACKBURN E. K., WILSON G. M. The pathogenesis of anaemia after partial gastrectomy. I. Development of anaemia in relation to time after operation, blood loss, and diet. Q J Med. 1959 Jan;28(109):21–34. [PubMed] [Google Scholar]
  4. Brown E. K., Settle E. A., Van Rij A. M. Food intake patterns of gastric bypass patients. J Am Diet Assoc. 1982 May;80(5):437–443. [PubMed] [Google Scholar]
  5. Buckwalter J. A. A prospective comparison of the jejunoileal and gastric bypass operations for morbid obesity. World J Surg. 1977 Nov;1(6):757–768. doi: 10.1007/BF01555933. [DOI] [PubMed] [Google Scholar]
  6. Bukoff M., Carlson S. Diet modifications and behavioral changes for bariatric gastric surgery. J Am Diet Assoc. 1981 Feb;78(2):158–161. [PubMed] [Google Scholar]
  7. Compston J. E., Vedi S., Ledger J. E., Webb A., Gazet J. C., Pilkington T. R. Vitamin D status and bone histomorphometry in gross obesity. Am J Clin Nutr. 1981 Nov;34(11):2359–2363. doi: 10.1093/ajcn/34.11.2359. [DOI] [PubMed] [Google Scholar]
  8. Eddy R. L. Metabolic bone disease after gastrectomy. Am J Med. 1971 Apr;50(4):442–449. doi: 10.1016/0002-9343(71)90333-0. [DOI] [PubMed] [Google Scholar]
  9. Griffen W. O., Jr, Bivins B. A., Bell R. M., Jackson K. A. Gastric bypass for morbid obesity. World J Surg. 1981 Nov;5(6):817–822. doi: 10.1007/BF01657968. [DOI] [PubMed] [Google Scholar]
  10. Hallberg L., Sölvell L., Zederfeldt B. Iron absorption after partial gastrectomy. A comparative study on the absorption from ferrous sulphate and hemoglobin. Acta Med Scand Suppl. 1966;445:269–265. [PubMed] [Google Scholar]
  11. Hartford C. E. Near-total gastric bypass for morbid obesity. Arch Surg. 1984 Mar;119(3):282–286. doi: 10.1001/archsurg.1984.01390150024006. [DOI] [PubMed] [Google Scholar]
  12. Hines J. D., Hoffbrand A. V., Mollin D. L. The hematologic complications following partial gastrectomy. A study of 292 patients. Am J Med. 1967 Oct;43(4):555–569. doi: 10.1016/0002-9343(67)90179-9. [DOI] [PubMed] [Google Scholar]
  13. Knecht B. H. Mason gastric bypass. Long-term follow-up and comparison with other gastric procedures. Am J Surg. 1983 May;145(5):604–608. doi: 10.1016/0002-9610(83)90102-2. [DOI] [PubMed] [Google Scholar]
  14. Linner J. H. Comparative effectiveness of gastric bypass and gastroplasty: a clinical study. Arch Surg. 1982 May;117(5):695–700. doi: 10.1001/archsurg.1982.01380290141025. [DOI] [PubMed] [Google Scholar]
  15. MacLean L. D., Rhode B. M., Shizgal H. M. Nutrition following gastric operations for morbid obesity. Ann Surg. 1983 Sep;198(3):347–355. doi: 10.1097/00000658-198309000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mahmud K., Kaplan M. E., Ripley D., Swaim W. R., Doscherholmen A. The importance or red cell B12 and folate levels after partial gastrectomy. Am J Clin Nutr. 1974 Jan;27(1):51–54. doi: 10.1093/ajcn/27.1.51. [DOI] [PubMed] [Google Scholar]
  17. Mahmud K., Ripley D., Doscherholmen A. Vitamin B 12 absorption tests. Their unreliability in postgastrectomy states. JAMA. 1971 May 17;216(7):1167–1171. doi: 10.1001/jama.216.7.1167. [DOI] [PubMed] [Google Scholar]
  18. Mahmud K., Ripley D., Swaim W. R., Doscherholmen A. Hematologic complications of partial gastrectomy. Ann Surg. 1973 Apr;177(4):432–435. doi: 10.1097/00000658-197304000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Meret S., Henkin R. I. Simultaneous direct estimation by atomic absorption spectrophotometry of copper and zinc in serum, urine, and cerebrospinal fluid. Clin Chem. 1971 May;17(5):369–373. [PubMed] [Google Scholar]
  21. Peltier G., Hermreck A. S., Moffat R. E., Hardin C. A., Jewell W. R. Complications following gastric bypass procedures for morbid obesity. Surgery. 1979 Oct;86(4):648–654. [PubMed] [Google Scholar]
  22. Rogers E. L., Douglass W., Russell R. M., Bushman L., Hubbard T. B., Iber F. L. Deficiency of fat soluble vitamins after jejunoileal bypass surgery for morbid obesity. Am J Clin Nutr. 1980 Jun;33(6):1208–1214. doi: 10.1093/ajcn/33.6.1208. [DOI] [PubMed] [Google Scholar]
  23. Stromberg B. V., Davis R. J., Danziger L. H. Relationship of serum transferrin to total iron binding capacity for nutritional assessment. JPEN J Parenter Enteral Nutr. 1982 Sep-Oct;6(5):392–394. doi: 10.1177/0148607182006005392. [DOI] [PubMed] [Google Scholar]
  24. Thompson G. R., Neale G., Watts J. M., Booth C. C. Detection of vitamin-d deficiency after partial gastrectomy. Lancet. 1966 Mar 19;1(7438):623–626. doi: 10.1016/s0140-6736(66)90823-3. [DOI] [PubMed] [Google Scholar]
  25. Thompson W. R., Amaral J. F., Caldwell M. D., Martin H. F., Randall H. T. Complications and weight loss in 150 consecutive gastric exclusion patients. Critical review. Am J Surg. 1983 Nov;146(5):602–612. doi: 10.1016/0002-9610(83)90296-9. [DOI] [PubMed] [Google Scholar]
  26. Tovey F. I., Clark C. G. Anaemia after partial gastrectomy: a neglected curable condition. Lancet. 1980 May 3;1(8175):956–958. doi: 10.1016/s0140-6736(80)91406-3. [DOI] [PubMed] [Google Scholar]
  27. Updegraff T. A., Neufeld N. J. Protein, iron, and folate status of patients prior to and following surgery for morbid obesity. J Am Diet Assoc. 1981 Feb;78(2):135–140. [PubMed] [Google Scholar]

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