Interview with Dr M. Elaine Eyster

Posted Mon, Aug, 24,2015

This author interview is by Dr M. Elaine Eyster, of Penn State College of Medicine. Dr Eyster's full paper, Anemia and the need for intravenous iron infusion after Roux en Y Gastric Bypass, is available for download in Clinical Medicine Insights: Blood Disorders.

Please summarise for readers the content of your article.
About 220,000 individuals had gastric bypass surgery In 2008. By far the most frequent type of surgery was the Roux en Y gastric bypass (RYGP) procedure. We became interested in the development of iron deficiency anemia because of the large number of women referred to hematology for IV iron therapy following RYGP surgery. It is well known that iron deficiency is the most common cause of anemia following RYGP surgery. However, data regarding the long term frequency of anemia and the need for intravenous (IV) iron replacement because of refractoriness or intolerance to oral iron are very limited.

How did you come to be involved in your area of study?
58% of 319 patients undergoing RYGP at our institution over a 5 year period developed anemia following surgery, and the rate continued to increase for at least 7 years. 8.5% of all patients and 22% of the 122 with anemia received IV iron replacement with good response an average of 4 years following surgery. Women of menstrual age at the time of surgery were at the highest risk for development of anemia.

What was previously known about the topic of your article?
Iron deficiency was diagnosed by measuring levels of serum ferritin which is a poor marker for iron deficiency in the presence of obesity. Studies to determine the true magnitude of this problem will require the measurement of the iron regulatory protein, hepcidin, when clinical testing becomes available.

How has your work in this area advanced understanding of the topic?
IV iron therapy is costly and not without risk. Identification of those at highest risk for development of iron deficiency anemia requiring IV iron replacement following RYGP surgery will require a better understanding of the adaptive mechanisms that allow some individuals to continue to absorb adequate amounts of oral iron, even though iron absorptive areas have been bypassed.

What do you regard as being the most important aspect of the results reported in the article?
Challenges with long term follow up and quality initiatives in this group of patients may be difficult to overcome in our fragmented healthcare system with multiple providers and payers.

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