Anaemia following gastric operations for peptic ulceration in dublin: II. Deficiency of iron and vitamin B12

Summary

• 1. The incidence of anaemia in a group of 69 partial gastrectomy cases selected at random was 40.5%. Iron deficiency anaemia was present in 28 out of 35 anaemic patients. Four out of a group of 77 showed partial or complete megaloblastic change in the bone marrow (5.8%). Serum vitamin B12 levels below 150 µµg. per 100 ml. were found in 7 out of 61 post-gastrectomy patients (11.5%).

• 2. One patient who had undergone gastro-enterostomy had partial megaloblastic change in the marrow. The serum vitamin B12 and the B12 absorption were both low in this case. The faecal fat excretion of the 5 gastro-enterostomy patients was above 7g per day.

• 3. No conclusion was drawn as to the aetiology of iron deficiency following partial gastrectomy, though in this series dietary iron deficiency was considered to be a contributory factor.

• 4. Low serum vitamin B12 levels were significantly related to presumptive evidence of achlorhydria, and to partial gastrectomy for a gastric as opposed to a duodenal ulcer. Low serum vitamin B12 levels were not related to changes in the jejunal mucosa nor to the incidence of steatorrhoea. These findings support the view that deficiency of B12 is due to atrophy of the mucosal lining of the gastric remnant and not to abnormality of the small intestine.