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. 1967 Feb 18;96(7):411–417.

Iron-Deficiency Anemia After Partial Gastrectomy

M C Geokas, R D McKenna
PMCID: PMC1935982  PMID: 6019057

Abstract

Although the mechanism for its development is not well understood, iron-deficiency anemia is a well-recognized consequence of partial gastrectomy. The reported incidence varies considerably, depending upon the criteria used to define anemia, and other factors. Rapid emptying of the gastric remnant, intestinal “hurry”, and borderline dietary-iron intake, with or without concomitant blood loss, produce malabsorption of some forms of iron that appears to be responsible for development of the deficiency. The diagnosis rests on hematological findings in the peripheral blood, the evaluation of iron stores, epithelial changes, and the response to adequate treatment. Oral iron therapy can be both effective and inexpensive and should form the mainstay of treatment.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDERSON C. D., GUNN R. T., WATT J. K. Results of partial gastrectomy in treatment of peptic ulcer. Br Med J. 1955 Feb 26;1(4912):508–511. doi: 10.1136/bmj.1.4912.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BANNERMAN R. M., BEVERIDGE B. R., WITTS L. J. ANAEMIA ASSOCIATED WITH UNEXPLAINED OCCULT BLOOD LOSS. Br Med J. 1964 May 30;1(5395):1417–1419. doi: 10.1136/bmj.1.5395.1417. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BENEDICT E. B. Benign inflammatory postoperative esophageal stenosis. Gastroenterology. 1960 Sep;39:285–292. [PubMed] [Google Scholar]
  4. BLAKE J., RECHNITZER P. A. The haematological and nutritional effects of gastric operations. Q J Med. 1953 Oct;22(88):419–437. [PubMed] [Google Scholar]
  5. BRUMMER P. The significance of Achlorhydria for the etiology of iron-deficiency anemia. Acta Med Scand. 1950;137(1):43–47. doi: 10.1111/j.0954-6820.1950.tb11364.x. [DOI] [PubMed] [Google Scholar]
  6. CHOUDHURY M. R., WILLIAMS J. Iron absorption and gastric operations. Clin Sci. 1959 Nov;18:527–532. [PubMed] [Google Scholar]
  7. CREAMER B., SHORTER R. G., BAMFORTH J. The turnover and shedding of epithelial cells. I. The turnover in the gastro-intestinal tract. Gut. 1961 Jun;2:110–118. doi: 10.1136/gut.2.2.110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. CROSBY W. H. A concept of the pathogenesis of anemia applied to disorders of the intestinal mucosa. Am J Dig Dis. 1961 Jun;6:492–498. doi: 10.1007/BF02231066. [DOI] [PubMed] [Google Scholar]
  9. CROSBY W. H., CONRAD M. E., Jr, WHEBY M. S. THE RATE OF IRON ACCUMULATION IN IRON STORAGE DISEASE. Blood. 1963 Oct;22:429–440. [PubMed] [Google Scholar]
  10. GOLDBERG A., LOCHHEAD A. C., DAGG J. H. Histamine-fast achlorhydria and iron absorption. Lancet. 1963 Apr 20;1(7286):848–850. doi: 10.1016/s0140-6736(63)91623-4. [DOI] [PubMed] [Google Scholar]
  11. GROSSMAN M. I., MATSUMOTO K. K., LICHTER R. J. Fecal blood loss produced by oral and intravenous administration of various salicylates. Gastroenterology. 1961 Mar;40:383–388. [PubMed] [Google Scholar]
  12. HOBBS J. R. Iron deficiency after partial gastrectomy. Gut. 1961 Jun;2:141–149. doi: 10.1136/gut.2.2.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. HOBBS J. R. Iron deficiency after partial gastrectomy. Gut. 1961 Jun;2:141–149. doi: 10.1136/gut.2.2.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. IRONS G. V., Jr, KIRSNER J. B. ROUTINE CHEMICAL TESTS OF THE STOOL FOR OCCULT BLOOD: AN EVALUATION. Am J Med Sci. 1965 Mar;249:247–260. doi: 10.1097/00000441-196503000-00001. [DOI] [PubMed] [Google Scholar]
  15. JACOBI H., PFLEGER K., RUMMEL W. Komplexbildner und aktiver Eisentransport durch die Darmwand. Naunyn Schmiedebergs Arch Exp Pathol Pharmakol. 1956;229(2):198–206. [PubMed] [Google Scholar]
  16. JACOBS P., BOTHWELL T., CHARLTON R. W. ROLE OF HYDROCHLORIC ACID IN IRON ABSORPTION. J Appl Physiol. 1964 Mar;19:187–188. doi: 10.1152/jappl.1964.19.2.187. [DOI] [PubMed] [Google Scholar]
  17. JONES C. T., WILLIAMS J. A., COX E. V., MEYNELL M. J., COOKE W. T., STAMMERS F. A. Peptic ulceration. Some haematological and metabolic consequences of gastric surgery. Lancet. 1962 Sep 1;2(7253):425–428. doi: 10.1016/s0140-6736(62)90282-9. [DOI] [PubMed] [Google Scholar]
  18. JOSKE R. A., BLACKWELL J. B. Alimentary histology in the malabsorption syndrome following partial gastrectomy. Lancet. 1959 Sep 19;2(7099):379–382. doi: 10.1016/s0140-6736(59)91641-1. [DOI] [PubMed] [Google Scholar]
  19. KERR D. N., DAVIDSON S. Gastrointestinal intolerance to oral iron preparations. Lancet. 1958 Sep 6;2(7045):489–492. doi: 10.1016/s0140-6736(58)91282-0. [DOI] [PubMed] [Google Scholar]
  20. KILPATRICK G. S. Prevalence of anaemia in the general population. A rural and an industrial area compared. Br Med J. 1961 Dec 30;2(5269):1736–1738. doi: 10.1136/bmj.2.5269.1736. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. KLIPSTEIN F. A. Iron and vitamin B12 deficiency following subtotal gastrectomy. Report of a patient developing polycythemia vera following treatment. Ann Intern Med. 1962 Jul;57:133–140. doi: 10.7326/0003-4819-57-1-133. [DOI] [PubMed] [Google Scholar]
  22. KOEPKE J. A., STEWART W. B. ROLE OF GASTRIC SECRETION IN IRON ABSORPTION. Proc Soc Exp Biol Med. 1964 Apr;115:927–929. doi: 10.3181/00379727-115-29081. [DOI] [PubMed] [Google Scholar]
  23. KRAUSE U. Iron deficiency and anaemia following partial gastrectomy. Acta Soc Med Ups. 1962;67:290–306. [PubMed] [Google Scholar]
  24. LANGE H. F., SKJAEGGESTAD O. Iron deficiency anemia in old age. Acta Med Scand. 1958 Nov 10;162(4):321–326. doi: 10.1111/j.0954-6820.1958.tb01778.x. [DOI] [PubMed] [Google Scholar]
  25. LANGE H. F. Salicylates and gastric hemorrhage. I. Occult bleeding. Gastroenterology. 1957 Nov;33(5):770–777. [PubMed] [Google Scholar]
  26. MENDEL G. A. Studies on iron absorption. I. The relationships between the rate of erythropoiesis, hypoxia and iron absorption. Blood. 1961 Dec;18:727–736. [PubMed] [Google Scholar]
  27. MICHAELIDES G. J., PHILIS H. C. Pathogenesis and treatment of the anaemia associated with hiatus hernia. Lancet. 1959 Mar 14;1(7072):552–554. doi: 10.1016/s0140-6736(59)92312-8. [DOI] [PubMed] [Google Scholar]
  28. MOLLIN D. L., HINES J. D. LATE POST-GASTRECTOMY SYNDROMES. OBSERVATIONS ON THE NATURE AND PATHOGENESIS OF ANAEMIA FOLLOWING PARTIAL GASTRECTOMY. Proc R Soc Med. 1964 Jul;57:575–580. doi: 10.1177/003591576405700718. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. OWREN P. A. The pathogenesis and treatment of iron deficiency anemia after partial gastrectomy. Acta Chir Scand. 1952 Dec 10;104(2-3):206–214. [PubMed] [Google Scholar]
  30. PAULSON M., HARVEY J. C. Hematological alterations after total gastrectomy: evolutionary sequences over a decade. J Am Med Assoc. 1954 Dec 25;156(17):1556–1560. doi: 10.1001/jama.1954.02950170010004. [DOI] [PubMed] [Google Scholar]
  31. PEDERSEN J., LUND J., OHLSEN A. S., KRISTENSEN H. P. O. Partial megaloblastic erythropoiesis in elderly achlorhydric patients with mild anaemia. Lancet. 1957 Mar 2;272(6966):448–453. doi: 10.1016/s0140-6736(57)90522-6. [DOI] [PubMed] [Google Scholar]
  32. SMITH M. D., MALLETT B. Iron absorption before and after partial gastrectomy. Clin Sci. 1957 Feb;16(1):23–34. [PubMed] [Google Scholar]
  33. SMITH M. D., PANNACCIULLI I. M. Absorption of inorganic iron from graded doses: its significance in relation to iron absorption tests and mucosal block theory. Br J Haematol. 1958 Oct;4(4):428–434. doi: 10.1111/j.1365-2141.1958.tb06044.x. [DOI] [PubMed] [Google Scholar]
  34. TASKER P. W. Concealed megaloblastic anaemia. Trans R Soc Trop Med Hyg. 1959 May;53(3):291–295. doi: 10.1016/0035-9203(59)90011-2. [DOI] [PubMed] [Google Scholar]
  35. TASKER P. W., MOLLIN D. L., BERRIMAN H. Vitamin-B12 deficiency in the megaloblastic anaemias of Malaya. Br J Haematol. 1958 Apr;4(2):167–176. doi: 10.1111/j.1365-2141.1958.tb03847.x. [DOI] [PubMed] [Google Scholar]
  36. TURNBULL A., CLETON F., FINCH C. A. Iron absorption. IV. The absorption of hemoglobin iron. J Clin Invest. 1962 Oct;41:1897–1907. doi: 10.1172/JCI104646. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Turnberg L. A. The absorption of iron after partial gastrectomy. Q J Med. 1966 Jan;35(137):107–118. [PubMed] [Google Scholar]
  38. WELLS C., WELBOURN R. Post-gastrectomy syndromes; a study in applied physiology. Br Med J. 1951 Mar 17;1(4706):546–554. doi: 10.1136/bmj.1.4706.546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. WHEBY M. S., JONES L. G. Role of transferrin in iron absorption. J Clin Invest. 1963 Jul;42:1007–1016. doi: 10.1172/JCI104785. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. WILLIAMS J. A. EFFECTS OF UPPER GASTRO-INTESTINAL SURGERY ON BLOOD FORMATION AND BONE METABOLISM. Br J Surg. 1964 Feb;51:125–135. doi: 10.1002/bjs.1800510208. [DOI] [PubMed] [Google Scholar]
  41. WINDSOR C. W. GASTRO-OESOPHAGEAL REFLUX AFTER PARTIAL GASTRECTOMY. Br Med J. 1964 Nov 14;2(5419):1233–1234. doi: 10.1136/bmj.2.5419.1233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. WIRTS C. W., GOLDSTEIN F. Studies of the mechanism of postgastrectomy steatorrhea. Ann Intern Med. 1963 Jan;58:25–36. doi: 10.7326/0003-4819-58-1-25. [DOI] [PubMed] [Google Scholar]

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