Iron Deficiency 4 years after surgery

[Recidivist 1,141]

Hi, all. I had bypass surgery almost exactly four years ago. I've taken bariatric Vitamins religiously and my bloodwork has always been perfect. Now, all of a sudden, I have Iron deficiency anemia. My most recent bloodwork showed an iron level of 24. Then, after five weeks of iron supplements, it had dropped to 14. What?? (I'm not exactly sure what those numbers mean, but my doctor says they are concerning.)

I know that bypass causes absorption issues. However, nothing has changed in terms of my diet or Vitamin intake. You would think this would have shown up long before now. Even my doctor is perplexed and is running tests to see what the cause might be.

Has anyone else experienced this issue years after surgery? I'd be especially interested in hearing from other men, as we are less prone to iron deficiency than women.

[summerset 5,265]

Iron deposits need a while to drain. Some people are not able to resorb oral iron supplements after bypass. However, a fast drop over the course of some weeks isn't really explained that way.

What about the other parameters? Ferritin, transferrin, hb?

[catwoman7 11,212]

Totally agree with summerset (of course!!). Ferritin level is just as important as the Iron level. It's the amount of stored iron in your body. Your body can tap into this storage when its iron levels get too low. And yes, it can take a long time for the ferritin level to deplete. . And also yes - there are a minority of bypass patients who don't absorb iron from oral supplements well, and therefore need to have occasional infusions to keep their iron levels up. They can bring your levels back up - but they might have to do an infusion to do it. Keep us posted...

P.S. there can be other reasons for low iron levels, which I'm sure they'll investigate, but the one mentioned is the most common for bypass patients (even though most of us are able to maintain iron levels with oral supplements)

Edited March 10, 2023 by catwoman7

[St77 87]

My Iron levels are typically low, though not like that. To make sure there wasn't something else going on, my doctor sent me to a hematologist for additional testing. He had me go through two iron infusions and my levels have been much better.

[Recidivist 1,141]

Thanks for the very helpful comments. My doctor didn't mention ferritin but I will ask him about it. I'm also going to see whether an infusion would be an option. (Medicare for all in Australia, and it can be difficult to get approved for some treatments like that.). Meanwhile, he is running tests for possible explanations for my anemia, other than malabsorption due to gastric bypass.

[summerset 5,265]

49 minutes ago, Recidivist said:

Meanwhile, he is running tests for possible explanations for my anemia, other than malabsorption due to gastric bypass.

That makes sense.

[RickM 1,747]

Are you working with your bariatric surgeon on this or your primary care family doctor? While this may well be unrelated to your WLS, a bariatric doctor will, of course, be more sensitive to issues specific to their specialty than a generalist.

My thoughts, not as an MD but just from having been around the WLS world for a couple decades, is that if it is WLS related, then given the fairly rapid onset of this, I would be looking for some bloodloss somewhere. With an RNY, the likely place would be the stoma, as that is a delicate structure that is easily irritated - if the semi-common marginal ulcers occur, that is where they usually happen. It may not be particularly symptomatic, but some minor blood loss can occur unnoticed until something like this shows up - one of those simple fecal smear tests can show whether there is any blood in your stool. If there is, then an endoscopy can show where it's coming from, and if there isn't any, then you have eliminated one possibility.

Iron supplements may or may not do much for an RNY person, as most of our mineral absorption occurs in the duodenum (part of the small intestine immediately downstream of the stomach) which gets bypassed along with the stomach; this is why iron infusions are not uncommon for malabsorbing WLS patients with iron problems. Were you on iron supplements to begin with and then increased the dosage, or just started when this problem showed up? I had an internal bleed a few years ago (non-WLS related, though certainly symptomatic) that sapped my iron levels, but not quite to the point of needing an infusion, and they came back after a few months of doubling my normal iron supplement (but I have a VSG, so not the same absorption problems as an RNY or DS will have,) and now I don't take any at all. For now.

Good luck in getting this worked out....

[Recidivist 1,141]

11 hours ago, RickM said:

Are you working with your bariatric surgeon on this or your primary care family doctor? While this may well be unrelated to your WLS, a bariatric doctor will, of course, be more sensitive to issues specific to their specialty than a generalist.

My bariatric surgeon is in Washington DC but I'm now living in Australia, so I'm working my primary care doctor. He does understand why I need to do regular blood tests and has been quite good about it.

11 hours ago, RickM said:

One of those simple fecal smear tests can show whether there is any blood in your stool. If there is, then an endoscopy can show where it's coming from, and if there isn't any, then you have eliminated one possibility.

Were you on Iron supplements to begin with and then increased the dosage, or just started when this problem showed up?

I have done the fecal smear and am awaiting results. My doctor wants to rule out colon cancer, but he has not mentioned the possibility of bleeding at the stoma. I'll raise this with him when I go in to discuss the results of this test.

I just started iron supplements in response to these most recent low iron levels. I'm also going to raise the possibility of an iron infusion at my next appointment.

Thanks so much for your thoughtful comments!

Edited March 12, 2023 by Recidivist

[loridee11 519]

Even pre-RNY I had really low Iron levels and have taken a supplement. It takes time for us to build back up. I'm sure your Dr. mentioned, but there are other Vitamins you can't take Iron with (if I recall correctly Calcium is one) and it absorbs better with Vitamin C taken at the same time. I take Iron +C daily now (end of day, 2 hours after my last calcium & multi) and that has helped bring mine up. Of course everyone is unique and I'm sure your dr. can help figure out what you need.

Good luck!

Edited April 12, 2023 by loridee11
correct vitamin to C