FOLLOW-UP RESULTS OF HEMATOLOGY DATA BEFORE AND AFTER RESTORATIVE PROCTOCOLECTOMY - CLINICAL OUTCOME

PURPOSE: This study was designed to investigate the development of ane mia during functional ileoanal pouch. METHODS: Eighty-three patients r eceived an ileoanal pouch between 1980 and 1987. The hematology data d eviations among the preoperative period, defunctionalized stage, and a fter ileal pouch in function were monitored. Aspects studied included serum hemoglobin, iron, folates, vitamin B-12, white blood cell, eryth rocyte sedimentation rate, pt-B-12, and fat absorption. Specimens were collected before colectomy, during ileostomy prior to pouch operation , before loop ileostomy closure, and at 6, 12, 18, 24, and 36 months a fter loop ileostomy closure. RESULTS:Two patients developed iron defi ciency anemia after 2.5 and 5 years of pouch function: one patient, a vegetarian, had low hemoglobin, iron, and vitamin B-12 postoperatively , the other patient developed low iron and hemoglobin 5 years after th e operation. Significant elevations of serum hemoglobin, iron, and fol ates were seen preoperatively vs. postoperatively from 123.46 +/- 2.84 5 g/l, 10.282 +/- 0.992 mu mol/l, and 9.983 +/- 1.308 mmol/l to 138.84 2 +/- 1.563 g/l (P < 0.0001), 17.544 +/- 1.529 mu mol/l (P < 0.0003), and 16.784 +/- 1.757 mmol/l (P < 0.01) (mean +/- SE) of the defunction alized loop ileostomy. Serum Bit decreased insignificantly. After loop ileostomy closure, at 6 and 36 months of functional ileal pouch-anal anastomosis, the elevations were still significant; serum hemoglobin w as P < 0.0001 and P < 0.01, and serum iron was P < 0.001 and P < 0.01, respectively. Vitamin B-12 levels decreased insignificantly at six mo nths in controls and significantly (P < 0.01) at 36 months. There was a significant increase of serum folates (P < 0.01 and P < 0.001). Pati ents with low iron were 50 percent at precolectomy, 23 percent with il eostomy, 16 percent with loop ileostomy, 15 percent at six-month follo w-up, and 11 percent at 12-month follow-up. Although only 3 percent an d 11 percent of the patients with ileal pouch-anal anastomosis had low serum vitamin B-12 values at the 12-month and 36-month follow-up, 31 percent and 36 percent had decreased Schilling tests. Thirty-three per cent and 41 percent had decreased C-14-triolein breath tests. In five patients vitamin B-12 deficiency began during the first six months of pouch function: in two patients after one year and in one patient afte r two years. Eight of 83 patients have had substitution therapy with v itamin B-12. The therapy was discontinued in three patients after two to four years; these patients developed no further symptoms and had no rmal Schilling tests in the succeeding 30 months to 46 months. Five pa tients continue with substitution after 40 months to 68 months. During the functional period, serum erythrocyte sedimentation rate and white blood cells were elevated in some controls on different occasions. Fo lates were normal throughout the functional period. CONCLUSION: For pr edicting hematologic data outcome in patients with functional ileal re servoir, the results justify the necessity for control during both man ipulative and functional periods until evaluations are reliable and sa tisfying.