Diagnóstico y tratamiento del déficit de hierro, con o sin anemia, pre y poscirugía bariátrica

doi:10.1016/j.endonu.2015.09.003

Endocrinología y Nutrición

Volume 63, Issue 1, January 2016, Pages 32-42

https://doi.org/10.1016/j.endonu.2015.09.003 Get rights and content

Resumen

La cirugía bariátrica es una modalidad terapéutica para la obesidad grave que se utiliza cada vez con más frecuencia, y permite que el paciente consiga una pérdida de peso mantenida en el tiempo y una resolución o mejoría de la mayor parte de las enfermedades asociadas. Una de las principales complicaciones a medio y a largo plazo es el déficit de hierro y la anemia ferropénica, que puede afectar hasta al 50% de los casos, y deteriora de manera importante la calidad de vida del paciente. Estas alteraciones pueden estar presentes desde el preoperatorio. El objetivo de la presente revisión es elaborar unos esquemas de diagnóstico y tratamiento del déficit de hierro y la anemia ferropénica en el pre y postoperatorio de la cirugía bariátrica.

Abstract

Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery.

Section snippets

Introducción

La obesidad mórbida es una enfermedad crónica caracterizada por el exceso de peso y de grasa corporal, y se asocia con un mayor riesgo de mortalidad y de padecer enfermedades crónicas, como diabetes tipo 2, hipertensión arterial, dislipidemia, enfermedades cardiovasculares, esteatohepatitis o enfermedad respiratoria, entre otras, además de un deterioro importante en la calidad de vida1, 2, 3, 4. La cirugía bariátrica (CB)⁵ es un tratamiento que ha demostrado ser eficaz a largo plazo para lograr

Diagnóstico y tratamiento de la anemia por déficit de hierro precirugía bariátrica (fig. 1)

La evaluación de los pacientes candidatos a CB incluye una valoración analítica con hemograma, estudio de la coagulación, bioquímica (función renal y hepática, estudio lipídico, metabolismo hidrocarbonado) y estudio de minerales y micronutrientes (hierro, ácido fólico, vitamina B₁₂ y vitamina D)11, 25, además de otras determinaciones que se consideren indicadas, atendiendo a la situación clínica y según el tipo de cirugía que se vaya a practicar. Esta evaluación se debería realizar al menos 30

Diagnóstico y tratamiento de anemia por déficit de hierro poscirugía bariátrica (fig. 3)

Aunque las técnicas de CB no suelen comportar un sangrado intraquirúrgico significativo, en el postoperatorio inmediato se recomienda la evaluación del nivel de Hb a las 24-48 h de la intervención.

Las guías de práctica clínica aconsejan prescribir suplementación con micronutrientes de manera crónica en todos los pacientes intervenidos mediante CB, adaptando la pauta a las características y riesgos propios de cada técnica quirúrgica. Las deficiencias más frecuentes afectan a la vitamina B₁₂, al

Discusión

La prevalencia de anemia por déficit de hierro es mayor entre los candidatos a CB que en la población general, incrementándose más todavía tras la intervención quirúrgica9, 11, 16, 17, 20, 23. En este sentido se aconseja la evaluación y tratamiento del déficit de hierro pre y posquirúrgico9, 11, 15, 19, 27, aunque las guías de práctica clínica no incluyen unas recomendaciones específicas sobre las pautas de tratamiento y prevención más adecuadas para la anemia ferropénica o ferropenia pre y

Financiación

Este artículo de revisión ha contado con el apoyo de una subvención por parte de Vifor Pharma España SL.

Conflicto de intereses

Los autores declaran no tener conflicto de intereses respecto al texto presentado y haber recibido honorarios como consultores de Vifor Pharma España, S.L.

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Cited by (14)

Postoperative management of specific complications: Anaemia, protein malnutrition and neurological disorders
2020, Nutrition and Bariatric Surgery
Currently, bariatric surgery remains the most effective therapeutic alternative for achieving sustained weight loss over time and resolving or improving most of its associated diseases; however, it can also have negative effects as a result of the anatomical modifications made, both restrictive and malabsorptive. The follow-up of the patient after bariatric surgery through a multidisciplinary team is essential to avoid possible complications and to treat those that appear from the beginning and avoid, in this way, greater repercussions. Throughout the next chapter, we will discuss three of the possible complications to be taken into account in these patients (anemia, protein malnutrition, and neurological complications), and protocolize their diagnosis and treatment.
Evaluation and treatment of iron deficiency, with or without anemia, in enhanced recovery after bariatric surgery
2020, Cirugia Espanola
Intravenous iron induced severe hypophophatemia in a gastric bypass patient
2019, Endocrinologia, Diabetes y Nutricion
Micronutrients deficiencies and undernutrition after obesity surgery
2017, Nutrition Clinique et Metabolisme
Après une chirurgie bariatrique, le risque de carence nutritionnelle dépend de l’importance de la perte de poids et du type de chirurgie ; les techniques purement restrictives (anneau gastrique) peuvent induire des troubles digestifs, une intolérance pour certains aliments et des comportements alimentaires mal adaptés en rapport avec des troubles du comportement alimentaire pré- ou postopératoires. Les apports en micronutriments, très réduits pendant la phase d’amaigrissement, justifient une supplémentation systématique en multivitamines comportant des éléments traces. Le « gastric bypass » entraîne une malabsorption de certains micronutriments. La « sleeve gastrectomy » semble entraîner un risque de carence moindre qu’après « gastric bypass » mais néanmoins significative à court terme, justifiant un dépistage régulier et souvent une supplémentation. La carence en fer est fréquente après les trois types d’intervention et concerne particulièrement les femmes non ménopausées. Le « gastric bypass » augmente le risque de carences en fer. La supplémentation n’est pas systématique mais pourrait se discuter chez les femmes avant la ménopause. Après cette intervention, la malabsorption du calcium et de la vitamine D entraîne un risque d’ostéoporose accéléré, notamment chez les femmes au moment de la ménopause. Le risque de carence en vitamine B12 est extrêmement élevé après « gastric bypass » et justifie d’une supplémentation systématique. L’encéphalopathie de Gayet-Wernicke n’est pas rare, notamment en cas d’intolérance alimentaire et de vomissements prolongés. Quelle que soit la technique chirurgicale, la surveillance nutritionnelle, la prescription de suppléments appropriés et la surveillance de l’adhésion des patients à ces mesures s’imposent. Ces patients doivent donc être suivis régulièrement et au long cours.
Obese patient is at risk of undernutrition, due to specific deficiencies or sarcopenia. After bariatric surgery, the risk of nutritional deficiency depends on the weight loss and the type of surgery; restrictive procedures (as gastric banding) can induce digestive disorders, food intolerance and inappropriate dietary behaviors related to pre- or postoperative eating disorders. Low micronutrient intake during weight loss justifies a systematic supplementation with multivitamins with trace elements. Gastric bypass causes micronutrients. Sleeve gastrectomy leads to a lower risk of deficiency than gastric bypass but significant in the short term, justifying regular screening and supplementation. Iron deficiency is frequent after these three interventions and especially in non-menopausal women. Gastric bypass increases the risk of iron deficiency. Supplementation is not systematic but may be discussed in women before menopause. After gastric bypass, the malabsorption of calcium and vitamin D leads to a risk of accelerated osteoporosis, especially in women at the time of menopause. The risk of vitamin B12 deficiency is extremely high after gastric bypass and justifies systematic supplementation. Gayet-Wernicke encephalopathy is not uncommon, particularly in cases of food intolerance and prolonged vomiting. Regardless of the surgical technique, nutritional monitoring, appropriate supplementation and monitoring of patient adherence to these measures are required. These patients should therefore be monitored regularly and over the long term.
Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review
2023, Journal of Clinical Medicine
Moderate anaemia refractory to oral iron in a pregnant woman with a history of bariatric surgery
2020, Nutricion Hospitalaria

View all citing articles on Scopus

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RevisiónDiagnóstico y tratamiento del déficit de hierro, con o sin anemia, pre y poscirugía bariátricaDiagnosis and treatment of iron deficiency, with or without anemia, before and after bariatric surgery

Resumen

Abstract

Section snippets

Introducción

Diagnóstico y tratamiento de la anemia por déficit de hierro precirugía bariátrica (fig. 1)

Diagnóstico y tratamiento de anemia por déficit de hierro poscirugía bariátrica (fig. 3)

Discusión

Financiación

Conflicto de intereses

Prog Cardiovasc Dis

Prog Cardiovasc Dis

Gastroenterology

Surg Obes Relat Dis

J Am Coll Surg

Cir Esp

Surg Obes Relat Dis

Surg Obes Relat Dis

Endocr Pract

J Acad Nutr Diet

Lancet

Br J Anaesth

Transfus Med Rev

Br J Anaesth

Br J Anaesth

Am J Clin Nutr

Am J Clin Nutr

Surg Obes Relat Dis

The medical complications of obesity

QJM

Morbid obesity-the new pandemic: medical and surgical management, and implications for the practicing gastroenterologist

Clin Transl Gastroenterol

Dyslipidemia in obesity: Mechanisms and potential targets

Nutrients

Documento de consenso sobre cirugía bariátrica

Rev Esp Obes

ASMBS statements/guidelines bariatric surgery in class I obesity (body mass index 30-35 kg/m2)

Surg Obes Rel Dis

Bariatric surgery in class I obesity: A position statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

Obes Surg

Iron deficiency and anaemia in bariatric surgical patients: Causes, diagnosis and proper management

Nutr Hosp

Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population

Obes Surg

Review article: The nutritional and pharmacological consequences of obesity surgery

Aliment Pharmacol Ther

Metabolic/bariatric surgery worldwide 2011

Obes Surg

Tratamiento anestésico perioperatorio de 300 pacientes con obesidad mórbida sometidos a cirugía bariátrica laparoscópica y breve revisión fisiopatológica

Rev Esp Anestesiol Reanim

Nutritional deficiencies in gastric bypass patients; incidence, time of occurrence and implications for post-operative surveillance

Obes Surg.

Iron deficiency before and after bariatric surgery: The need for iron supplementation

Neth J Med

Prevalence and outcomes of anemia in surgery: A systematic review of the literature

Am J Med

Nutritional profile of patients before and after Roux-en-Y gastric bypass: 3-year follow-up

Obes Surg

Revisión
Diagnóstico y tratamiento del déficit de hierro, con o sin anemia, pre y poscirugía bariátricaDiagnosis and treatment of iron deficiency, with or without anemia, before and after bariatric surgery

ASMBS statements/guidelines bariatric surgery in class I obesity (body mass index 30-35 kg/m²)