Unrecognized anemia after whipple – should we learn from gastric bypass?. (1st November 2020)

• Record Type: Journal Article
• Authors: Jackson, Terence; Vedantam, Shyam; Bradshaw, Rhiannon; Cho, Edward; Lim, Joseph; Nagatomo, Kei; Osman, Houssam; Jeyarajah, D. Rohan
• Is Part Of: Expert review of gastroenterology & hepatology. Volume 14:Number 11(2020)
• Page Start: 1119
• Page End: 1123
• Publication Date: 2020-11-01
• Subjects: Anemia -- bariatric -- iron -- pancreaticoduodenectomy -- whipple procedure; Gastroenterology -- Periodicals; Liver -- Diseases -- Periodicals; 616.3
• DOI: 10.1080/17474124.2020.1808459
• Languages: English
• ISSNs: 1747-4124

Abstract

ABSTRACT: Introduction: Several pathophysiologic changes after the Whipple procedure have been well described, but anemia has not. Post-surgical changes can impede micronutrient absorption. We hypothesize that patients post-pancreatoduodenectomy suffer from iron deficiency anemia. Methods: Patients who underwent a pancreatoduodenectomy from 2016 to 2018 were retrospectively evaluated. Preoperative, intraoperative, and postoperative data, including hemoglobin (Hb) levels and mean corpuscular volume (MCV) as well as therapies with chemoradiation, iron, and/or B12 were collected at 1-, 3-, 6-, and 12-months after surgery. Results: The dataset included 74 patients (median age: 64 years). Mean preoperative Hb and MCV were 11.7 ± 1.9 g/dl and 90.1 ± 7.3 fl, respectively. Significant changes in Hb were noted at 1 and 6 months (11.7 vs 10.9, p = 0.01 and 11.7 vs 11.3, p = 0.003, respectively), and in MCV were noted at 6 and 12 months (90.1 vs 94.6, p = 0.008 and 90.1 vs. 93.7, p = 0.02, respectively). Conclusions: All patients remained anemic after pancreatoduodenectomy. This was not linked to chemotherapy. Iron and vitamin B12 supplementation, given in a minority, did not ameliorate the anemia. Future studies should investigate this lack of aid, as nutrient supplementation may be an important change in the standard of care of these patients.