Intravenous iron replacement for persistent iron deficiency anemia after Roux-en-Y gastric bypass

2013 ◽  
Vol 9 (1) ◽  
pp. 129-132 ◽  
Author(s):  
Zachariah DeFilipp ◽  
John Lister ◽  
Daniel Gagné ◽  
Richard K. Shadduck ◽  
Lori Prendergast ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Intravenous Iron ◽  
Deficiency Anemia ◽  
Iron Replacement

Iron Deficiency Anemia Diagnosed in the Private Practice Setting,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3186-3186
Author(s):  
Thomas A Bensinger ◽  
Ayana M Elliott ◽  
Laura Hostovich ◽  
Martin D. Weltz
Keyword(s):  
Gastric Bypass ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Intravenous Iron ◽  
Deficiency Anemia ◽  
Practice Setting ◽  
Laboratory Studies ◽  
Menstrual Blood Loss

Abstract Abstract 3186 Introduction: Iron deficiency anemia (IDA) continues to be a problem in the United States in the 21st Century. Differentiating IDA from anemia of chronic disease (ACD) is important in the clinical practice setting because iron supplementation has been shown to be beneficial for IDA and may deleteriously affect ACD patients. We examined consecutive patients referred for a diagnosis of anemia in a single community-based hematology-oncology practice in the suburbs of a major city over an 8 month period. IDA was found amongst these patients. The common possible causes, symptoms and usual treatment for this subset of patients are reported. Methods: Records of all adult patients referred to the practice with a diagnosis of anemia and were then confirmed to be iron deficiency anemia from March 2010 until November 2010 were reviewed. Chart review analysis was performed to identify differences in gender, causes, symptoms, treatment plans, treatment efficacy, pertinent history and physical findings including laboratory studies - CBC, ferritin, iron/TIBC, reticulocyte count, review of the peripheral blood film, and often but not always, an erythropoietin level. Results: A significant number of patients (n = 130) demonstrated iron deficiency anemia. The vast majority of these patients were female (94%). Most patients were also premenopausal. Four patients were pregnant. The most common cause of iron deficiency anemia was heavy menstrual blood loss associated with the presence of uterine fibroids (67%) followed by, gastric bypass surgery (24%). Interestingly, a subset of patients (12%) had a history of both gastric bypass and heavy menstrual blood loss. Other associated causes found to be linked to IDA were gastrointestinal lesions, such as AV malformations, gastritis, including medication induced gastritis (nonsteroidal anti-inflammatory drugs), hiatal hernia and at least one colon cancer. Subjective symptoms of IDA included tiredness, weakness, exhaustion, brittle nails and hair loss. The finding of pica was quite extensive and often not reported by the patient unless questioned in detail. Pica symptoms included the desire for ice (pagophagia), clay or starch, and also revealed some unusual urges, including eating toilet paper or paper towels, dirt from a patient's rose garden, or the urge to chew gum with the amount exceeding several packages of greater than 10 sticks each per day. One patient reported eating leaves which were stripped from a garden plant. Laboratory studies on these patient subset revealed only 3 had a ferritin level greater than 20 ng/mL (3%). The MCV was less than 80 fl in 111 of the 130 patients. Thrombocytosis (a platelet count of greater than 400,000.103 ml) was an associated finding of IDA and occurred 40 of 130 patients (30%). The platelet count returned to normal in all but one patient post treatment. Conclusion: Iron deficiency is a pervasive problem that is not adequately assessed and treated. Many of our clinic patients developed iron deficiency anemia as a result of surgical intervention, such as gastric bypass surgery. We recommend identifying IDA early to treat patients efficaciously for optimal outcomes. Close attention should be given to key clinical indicators including low MCV and variant forms of pica syndrome which is a valid symptom of iron deficiency. Our experience with administering intravenous iron preparations suggests that patients have improvements in overall well being often within a few days of the first infusion. The pica syndrome resolved in approximately two weeks post the first dose of iron in most patients, even prior to demonstrating any significant improvement in the hemoglobin and hematocrit or the MCV levels. This may imply that iron deficiency affects fundamental enzymes for metabolic processes found in the oral mucosa leading to the PICA. Intravenous iron administration was often used in our practice to bring the hemoglobin and hematocrit to more favorable levels in order to reduce symptoms of iron deficiency or to undergo surgical procedures and childbirth as needed. There was an occasional reaction to intravenous iron that included pruritis, back pain and an unusual swelling in the joints (e.g., knees). We have treated these patients with 100 mg of hydrocortisone intravenously and 25 mg of diphenhydramine intravenously. All reactions usually abated within 30 minutes. We had no fatal reactions to the use of intravenous iron preparations. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Iron Malabsorption Associated with Elevated Serum Gastrin

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3364-3364
Author(s):  
Michael Boxer
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Serum Gastrin ◽  
Elevated Serum ◽  
Intravenous Iron ◽  
Gastrin Level ◽  
Deficiency Anemia ◽  
Gliadin Antibodies ◽  
Gluten Enteropathy ◽  
Iron Replacement

Iron deficiency anemia (IDA) in the absence of gastrointestinal (GI) bleeding is a common cause for hematologic consultation. During a 24 month period a single hematologist evaluated 36 patients for iron deficiency anemia which was unresponsive to oral iron replacement. Patients who had active GI bleeding, bariatric or extensive gastric surgery, or menorrhagia were excluded from this study. Hematologic testing included a serum gastrin level, Helicobacter pylori antibodies, and anti gliadin antibodies. Serum cobalamin levels were not measured. 28 patients had elevated gastrin levels, 3 patients had positive anti gliadin antibodies, and 2 patients had positive anti Helicobacter antibodies. One patient had both an elevated gastrin level and a positive anti gliadin antibody. One patient had both an elevated gastrin level and an anti helicobacter antibody. One patient had profound hypothyroidism (TSH>100) whose iron deficiency corrected with thyroid replacement. Proton pump inhibitors (PPI) raise the serum gastrin levels. 16 patients with an elevated serum gastrin level were taking PPI when the gastrin measurements were obtained. However, the remaining 14 patients were not taking a PPI when gastrin levels were measured. 23 patients were women and 13 were men. No patient was under 40 years old. 11 were between 45 and 59 years of age. 25 were between 63 and 88 years old. 26 patients were non Hispanic caucasians, 8 were Hispanic caucasians, and 1 patient was African American. In the absence of a gastrin secreting tumor or use of a PPI an elevated gastrin suggests that autoimmune gastric atrophy is present which can cause both iron and vitamin B12 malabsorption. Iron malabsorption does occur in gluten enteropathy which is diagnosed by positive anti gliadin antibodies. Helicobacter infections are also associated with iron malabsorption. Intravenous iron replacement with iron dextran was administered to 35 patients. Two patients had minor reactions to iron dextran. One subsequently received iron sucrose without incident, but the other patient did not tolerate iron sucrose, iron carboxymaltose, and ferric gluconate. The 28 patients with an elevated gastrin has a complete response to intravenous iron replacement except the one patient who was intolerant to all intravenous iron preparations. Those with celiac sprue and helicobacter infections responded incompletely to intravenous iron therapy and required dietary modification and anti helicobacter therapy. An abnormal gastric biopsy was found in 3 of 28 patients with an elevated serum gastrin level. None of the 4 patients with a Helicobacter infection, gluten enteropathy, or severe hypothyroidism had a diagnostic esophagogastroduodenoscopy. In this small study no clear relationship between an elevated gastrin and either gluten enteropathy or a Helicobacter was present. This study has two interesting conclusions. First PPI therapy alone can cause iron deficiency anemia due to iron malabsorption. Also autoimmune gastric atrophy is a probable cause of IDA even when the gastrointestinal evaluation does not demonstrate bleeding or gastric atrophy. Both conditions are associated with an elevated serum gastrin. Serum gastrin measurement should be obtained during an evaluation for iron deficiency of unclear etiology. Disclosures No relevant conflicts of interest to declare.

scholarly journals Intravenous Iron Induced Cytopenias(Leukopenia,Neutropenia,Lymphocytopenia) Among Arab Population with Iron Deficiency Anemia

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 18-19
Author(s):  
Hussam A Almasri ◽  
Ashraf Tawfiq Soliman ◽  
Vincenzo Desanctis ◽  
Rita Wafik Ahmad ◽  
Mustafa A Al-Tikrity ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Side Effect ◽  
Intravenous Iron ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Ferric Carboxymaltose ◽  
Iv Iron ◽  
Iron Replacement

Introduction Iron deficiency anemia (IDA) is the most common cause of anemia in both developed and developing countries, particularly affecting females in the child bearing age and children. The treatment of IDA is a major health goal, it consists of treating the underlying cause and iron supplements. Iron replacement comes in form of oral or intravenous, there are certain side effects of this therapy including constipation and allergy. Leukopenia as a side effect of iron therapy is under reported in the literature as only sporadic cases were prescribed. We conducted a study to clarify this issue and to check for its clinical significance. Objective: To assess the relationship between iron therapy (intravenous) and leukopenia, neutropenia or lymphocytopenia, and its impact on patient's clinical settings. Materials and Methods We retrospectively reviewed the electronic medical records of patients attended Haematology clinic for iron deficiency anemia and treated with intravenous iron (ferric carboxymaltose or iron saccharide) over 2 years in Hamad Medical Corporation, Doha/Qatar. Adult female patients with IDA cases who received IV iron were included. anemia due to other nutrients deficienciesa nd conditions (including other medications) that may alter WBCs count were excluded.Age, Ethnicity, BMI, Complete blood count and iron studies data were collected before and after treatment with IV iron therapy. Infection occurrence at the time of IDA and leukopenia, the use of antibiotics and infection related complications were also collected. Leukopenia was defined as WBCs count to be less than 4000/microlitre, Neutropenia as ANC less than 1500/microlitre and lymphocytopenia as lymphocytes less than 1000/mocrolitre. Statistical analysis was done using mean , SD and t test. Results After iron therapy, out of 1567 case of iron deficiency anemia, 30 cases (1.914%) have leukopenia,15 cases (0.957%) have neutropenia and 12 cases (0.765%) have lymphocytopenia. All had normal readings before treatment. 2 patients (6.66%) had infection, 1 had upper respiratory tract infection and 1 urinary tract infection, the latter was treated with antibiotics, none reported infection related complications Discussion Leukocytopenia is defined as low WBCs circulating in the blood and this can be caused by low neutrophils count, low lymphocytes count, other WBCs components or combined. Some previous reported cases generated the idea of a possible connection between iron supplement therapy and leukopenia, Brito-Babapulle et al reported a case of fatal bone marrow suppression linked to ferric carboxymaltose therapy in a patient with IDA. The pathophysiology is not well understood but thought to be a toxic effect of iron on bone marrow and it can affect all cell lineages. Our findings suggest possible iron replacement side effect as there was significant drop of the WBCs count after treating IDA patients with IV iron, however this association was not common. There was no life threatening or serious infections in the affected patients, which can suggest that most of these cases are mild and transient. More studies are needed to address this issue, particularly on larger scales. Patient education also may be appreciated before treatment with IV iron. Conclusions: Leukopenia in form of neutropenia or lymphocytopenia maybe a side effect of IV iron therapy. Clinical significance is limited in view of current literature further studies needed to elaborate more in this important adverse event. Figure Disclosures No relevant conflicts of interest to declare.

Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy

1996 ◽  
Vol 69 (2) ◽  
pp. 121-124 ◽  
Author(s):  
Abdul-Kareem Al-Momen ◽  
Abdulaziz Al-Meshari ◽  
Lulu Al-Nuaim ◽  
Abdulaziz Saddique ◽  
Zainab Abotalib ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Intravenous Iron ◽  
Iron Sucrose ◽  
Deficiency Anemia ◽  
Anemia During Pregnancy
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