Background and Goal of the study
Anemia is common among post-bariatric surgery patients. Besides impairing nutrient absorption, bariatric surgery can induce chronic gastro-intestinal blood loss and iron-loosing enteropathy, which all lead to iron deficiency and anemia. Preoperative anemia is an independent risk factor for red blood cell transfusion (RBC) and increase postoperative morbi-mortality. Intravenous iron therapy has been proposed as a fast and efficacious strategy to increase hemoglobin and minimize exposure to RBC transfusions.
The aim of this study was to evaluate hemoglobin and hematocrit response to intravenous ferric carboxymaltose in post-bariatric patients proposed for abdominoplasty and mammoplasty.
Material and Methods
We retrospectively analyzed records from patients who had history of gastric bypass and were proposed for intravenous iron treatment before abdominoplasty or mammoplasty, between 2013 and 2015. We evaluated how patient´s hemoglobin and hematocrit values responded to treatment, using t-student statistic model of SPSS 17.
Results and Discussion
A total of 47 patients (n=47) were submitted to a single dose of ferric carboxymaltose (1000mg) preoperatively. All patients were females (n=47), 45 were classified as ASA II and 2 as ASA III. Mean age was 40,2 ± 7,79 years and mean weight 69 ±12,2kg. Patients underwent gastric bypass surgery between 2006 and 2015. Mean preoperative hemoglobin and hematocrit
level was 9,72 ±0,75g/dL and 31,2 ±1,95% respectively. No adverse reactions were documented with ferric carboxymaltose administration and control hemogram were made 3 weeks after therapy. Pos-treatment mean hemoglobin and hematocrit value was 11.5 ±0,28g/dL (p=0.0138) and 36.2 ±1,97% (p=0,0132) respectively, which represented an average hemoglobin and hematocrit increase of 1,8 ±0,97g/dL and 5 ±2,87%, respectively. Surgeries were scheduled within 1 and 2 weeks after control hemogram. All patients were discharged 3 days after surgery and none needed to be transfused in the postoperative setting.
Conclusion
A single administration of ferric carboxymaltose (1000 mg) seems to be a safe and efficacious strategy to significantly improve preoperative hemoglobin and hematocrit values in post-bariatric surgery patients proposed for elective surgery. These results highlight the relevance of a good blood management practice.

Post-bariatric surgery anemia: hemoglobin and hematocrit response to intravenous ferric carboxymaltose before plastic surgery