Anemia after biliopancreatic diversion

At present, biliopancreatic diversion (BPD) is one of the most effective surgery for the treatment of morbid obesity. However, long-term complications, including different types of anemia are known to occur after such intervention. Objective of the study. To investigate pathogenetic mechanisms of anemia and clinical condition of the patients undergone BPD taking into account risk factors of anemia development, its therapy and prevention. Material and methods. Eighty patients who had undergone BPD surgery were included in the study. Postoperative oral administration of iron medications (IMs) was recommended to all patients. 49 of them regularly received IMs, 31 patients were not given IMs or took them for no more than 2 months after surgery. The follow-up was 3-7 years. Results. A reliable decrease of hemoglobin levels was observed in all patients after BPD. This reduction began as early as month 3 after surgery and progressed during the 7 year follow-up. Iron deficiency anemia (IDA) was diagnosed in 30% of the patients after BPD. Mean levels of hemoglobin, ferritin and serum iron after BPD were significantly lower in patients having risk factors of IDA as well as in patients not receiving iron therapy. Iron deficiency anemia was revealed in 33.3% of the patients regularly receiving IMs in doses containing 100 mg elemental iron per day. There was no significant decrease of vitamin B12 and folic acid levels during 7 years of follow-up. Only one case (1.25%) of B12 deficiency anemia was registered. Normochromic normocytic anemia characterized by normal serum iron and increased ferritin and C-reactive protein levels, was diagnosed after BPD in 7.85% of the patients. Conclusion. BPD surgery is the important risk factor of anemia (especially IDA) development. In compliant patients. Continuous intake of IMs makes up for iron deficiency but in some others IDA occurred despite regular IMs administration. Normochromic normocytic anemia after BPD may be due to chronic inflammation.