Advertisement

Hematological Variables and Iron Status in Abdominoplasty After Bariatric Surgery

  • Juan C. Montano-PedrosoEmail author
  • Elvio Bueno Garcia
  • Mayara Mytzi de Aquino Silva
  • Lydia Masako Ferreira

Abstract

Abdominoplasty, the treatment for abdominal wall deformity stemming from weight loss after bariatric surgery, can cause postoperative anemia. Moreover, bariatric surgery has been associated with iron deficiency, which by itself can compromise erythropoiesis. It is essential to understand the development of anemia after postbariatric abdominoplasty. The authors’ study group consisted of 32 adult women who had received bariatric surgery. Mean hemoglobin levels for treatment group decreased from 12.98 to 10.8 g/dL after 48 h and increased on day 7 to 11.53 g/dL, but did not increase further after day 7. The reticulocyte number increased in the first week. Serum iron and transferrin saturation index fell during the first week and remained low. Ferritin levels increased nonsignificantly from 29.77 to 37.24 ng/mL at week 1 and then fell until they were decreased (16.44 ng/mL) by 8 week. As expected, hemoglobin fell after abdominoplasty. However, after a one-third recovery of hemoglobin concentrations by week 1 postoperative, they failed to return to preoperative levels by the eighth week. Additionally, by the eighth postoperative week, 45 % of abdominoplasty patients had developed an iron deficiency and hemoglobin deficit

Keywords

Bariatric Surgery Hemoglobin Level Iron Deficiency Ferritin Level Serum Iron 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Low S, Chin MC, Deurenberg-Yap M. Review on epidemic of obesity. Ann Acad Med Singapore. 2009;38(1):57–9.PubMedGoogle Scholar
  2. 2.
    Catenacci VA, Hill JO, Wyatt HR. The obesity epidemic. Clin Chest Med. 2009;30(3):415–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Santos LM, Oliveira IV, Peters LR, Conde WL. Trends in morbid obesity and in bariatric surgeries covered by the Brazilian Public Health System. Obes Surg. 2010;20(7):943–8.CrossRefPubMedGoogle Scholar
  4. 4.
    James PT. Obesity: the worldwide epidemic. Clin Dermatol. 2004;22(4):276–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(140):1724–37.CrossRefPubMedGoogle Scholar
  6. 6.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14(9):1157–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Clegg A, Colquitt J, Sidhu M, Royle P, Walker A. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord. 2003;27(10):1167–77.CrossRefPubMedGoogle Scholar
  8. 8.
    Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for body contour surgery. Clin Plast Surg. 2004;31(4):601–10.CrossRefPubMedGoogle Scholar
  9. 9.
    Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83(5):403–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(3):288–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Marinella MA. Anemia following Roux-en-Y surgery for morbid obesity: a review. South Med J. 2008;101(10):1024–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Poulose BK, Holzman MD, Zhu Y, Smalley W, Richards WO, Wright JK, Melvin W, Griffin MR. National variations in morbid obesity and bariatric surgery use. J Am Coll Surg. 2005;201(1):77–84.CrossRefPubMedGoogle Scholar
  13. 13.
    Brolin RE, Gorman RC, Milgrim LM, Kenler HA. Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies. Int J Obes. 1991;15(10):661–7.PubMedGoogle Scholar
  14. 14.
    Fraccalvieri M, Datta G, Bogetti P, Verna G, Pedrale R, Bocchiotti MA, Boriani F, Obbialero FD, Kefalas N, Bruschi S. Abdominoplasty after weight loss in morbidly obese patients: a 4-year clinical experience. Obes Surg. 2007;17(10):1319–24.CrossRefPubMedGoogle Scholar
  15. 15.
    Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH. Body image and quality of life in post massive weight loss body contouring patients. Obesity. 2006;14(9):1626–36.CrossRefPubMedGoogle Scholar
  16. 16.
    Bussolaro RA, Garcia EB, Barbosa MV, Omonte IR, Huijsmans JP, Bariani RL, Ferreira LM. Post-bariatric abdominoplasty: skin sensation evaluation. Obes Surg. 2010;20(7):855–60.CrossRefPubMedGoogle Scholar
  17. 17.
    Wallach SG. Abdominal contour surgery for the massive weight loss patient: the fleur-de-lis approach. Aesthet Surg J. 2005;25(5):454–65.CrossRefPubMedGoogle Scholar
  18. 18.
    Agha-Mohammadi S, Hurwitz DJ. Potential impacts of nutritional deficiency of postbariatric surgery patients in body contouring surgery. Plast Reconstr Surg. 2008;122(6):1901–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Bacuzzi A, Dionigi G, Piffaretti G, Tozzi M, Del Romano M, Guzzetti L, Paracchini F, Villa F, Cuffari S. Preoperative methods to improve erythropoiesis. Transplant Proc. 2011;43(1):324–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008;36(9):2667–74.CrossRefPubMedGoogle Scholar
  21. 21.
    Glance LG, Dick AW, Mukamel DB, Fleming FJ, Zollo RA, Wissler R, Salloum R, Meredith UW, Osler TM. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114(2):283–92.CrossRefPubMedGoogle Scholar
  22. 22.
    Isbister JP, Shander A, Spahn DR, Erhard J, Farmer SL, Hofmann A. Adverse blood transfusion outcomes: establishing causation. Transfus Med Rev. 2011;25(2):89–101.CrossRefPubMedGoogle Scholar
  23. 23.
    Conlon NP, Bale EP, Herbison GP, McCarroll M. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65 years old. Anesth Analg. 2008;106(4):1056–61.CrossRefPubMedGoogle Scholar
  24. 24.
    Montano-Pedroso JC, Garcia EB, Omonte IR, Rocha MG, Ferreira LM. Hematological variables and iron status in abdominoplasty after bariatric surgery. Obes Surg. 2013;23(1):7–16.CrossRefPubMedGoogle Scholar
  25. 25.
    Song AY, Jean RD, Hurwitz DJ, Fernstrom MH, Scott JA, Rubin JP. A classification of contour deformities after bariatric weight loss: the Pittsburgh Rating Scale. Plast Reconstr Surg. 2005;116(5):1535–44.CrossRefPubMedGoogle Scholar
  26. 26.
    Costa LF, Landecker A, Manta AM. Optimizing body contour in massive weight loss patients: the modified vertical abdominoplasty. Plast Reconstr Surg. 2004;114(7):1917–23.CrossRefPubMedGoogle Scholar
  27. 27.
    Ruz M, Carrasco F, Rojas P, Codoceo J, Inostroza J, Rebolledo A, Basfi-fer K, Csendes A, Papapietro K, Pizarro F, Olivares M, Sian L, Wesrcott JL, Hambidge KM, Krebs NF. Iron absorption and iron status are reduced after Roux-en-Y gastric bypass. Am J Clin Nutr. 2009;90(3):527–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Dalcanale L, Oliveira CPS, Faintuch J, Nogueira MA, Rondó P, Lima VM, Mendonça S, Pajecki D, Mancini M, Carrilho FJ. Long-term nutritional outcome after gastric bypass. Obes Surg. 2010;20(2):181–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LB, Kenler HA, Cody RP. Prophylactic iron supplementation after Roux-en-Y gastric bypass: a prospective, double-blind, randomized study. Arch Surg. 1998;133(7):740–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc. 2004;104(8):1258–64.CrossRefPubMedGoogle Scholar
  31. 31.
    Von Drygalski A, Andris DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract. 2009;24(2):217–26.CrossRefGoogle Scholar
  32. 32.
    Marín-Bertolín S, Valía Vera JC, González-Martínez R, Neira Giménez C, Amorrotu-Velayos J. Blood loss and hematological recovery following reduction mammaplasty and dermolipectomy: a prospective study. Aesthetic Plast Surg. 1998;22(3):168–72.CrossRefPubMedGoogle Scholar
  33. 33.
    Dini M, Mori A, Cassi LC, Lo Russo G, Lucchese M. Circumferential abdominoplasty. Obes Surg. 2008;18(11):1392–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Grathwohl KW, Bruns BJ, LeBrun CJ, Ohno AK, Dillard TA, Cushner HM. Does hemodilution exist? Effects of saline infusion on hematologic parameters in euvolemic subjects. South Med J. 1996;89(1):51–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Hillman RS. Characteristics of marrow production and reticulocyte maturation in normal man in response to anemia. J Clin Invest. 1969;48(3):443–53.PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Wallis JP, Wells AW, Whitehead S, Brewster N. Recovery from post- operative anaemia. Transfus Med. 2005;15(5):413–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Biesma DH, Van de Wiel A, Beguin Y, Kraaijenhagen RJ, Marx JJ. Post-operative erythropoiesis is limited by the inflammatory effect of surgery on iron metabolism. Eur J Clin Invest. 1995;25(6):383–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Van Iperen CE, Kraaijenhagen RJ, Biesma DH, Beguin Y, Marx JJ, Van de Wiel A. Iron metabolism and erythropoiesis after surgery. Br J Surg. 1998;85(1):41–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Killip S, Bennett JM, Chambers MD. Iron deficiency anemia. Am Fam Physician. 2007;75(5):671–8.PubMedGoogle Scholar
  40. 40.
    Wish JB. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol. 2006;1 Suppl 1:S4–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Ganz T. Hepcidin and iron regulation, 10 years later. Blood. 2011;117(17):4425–33.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Ganz T, Nemeth E. Hepcidin and disorders of iron metabolism. Annu Rev Med. 2011;62:347–60.CrossRefPubMedGoogle Scholar
  43. 43.
    García-Erce JA, Cuenca J, Martínez F, Cardona R, Pérez-Serrano L, Muñoz M. Perioperative intravenous iron preserves iron stores and may hasten the recovery from post-operative anaemia after knee replacement surgery. Transfus Med. 2006;16(5):335–41.CrossRefPubMedGoogle Scholar
  44. 44.
    Davison SP, Clemens MW. Safety first: precautions for the massive weight loss patient. Clin Plast Surg. 2008;35(1):173–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Juan C. Montano-Pedroso
    • 1
    Email author
  • Elvio Bueno Garcia
    • 2
  • Mayara Mytzi de Aquino Silva
    • 2
  • Lydia Masako Ferreira
    • 2
  1. 1.Division of Plastic Surgery, Plastic Surgery Post-Graduation ProgramFederal University of São PauloSão PauloBrazil
  2. 2.Plastic Surgery DivisionFederal University of São PauloSão PauloBrazil

Personalised recommendations