PROPHYLACTIC IRON SUPPLEMENTATION AFTER ROUX-EN-Y GASTRIC BYPASS - A PROSPECTIVE, DOUBLE-BLIND, RANDOMIZED STUDY

Objective: To determine whether prophylactic oral iron supplements (32 0 mg twice daily) would protect women from iron deficiency and anemia after Roux-en-Y gastric bypass. Design: Prospective, double-blind, ran domized study in which 29 patients received oral iron and 27 patients received a placebo beginning 1 month after Roux-en-Y gastric bypass. S etting: Tertiary care medical center. Patients and Interventions: Comp lete blood cell count and serum levels of iron, total iron binding cap acity, ferritin, vitamin B-12, and folate were determined preoperative ly and at 6-month intervals postoperatively in 56 menstruating women w ho had Roux-en-Y gastric bypass. Main Outcome Measure: Incidence of ir on deficiency and other hematological abnormalities in each treatment group. Results: Hemoglobin, hematocrit, and vitamin Bit levels were si gnificantly decreased compared with preoperative values in both groups . Conversely, folate levels increased significantly over time in both groups. Oral iron consistently prevented development of iron deficienc y in the iron group. Ferritin levels did not change significantly in t he iron group. However, in placebo-treated patients, ferritin levels 2 years postoperatively were significantly decreased compared with preo perative levels. There was no difference in the incidence of anemia be tween the 2 groups. However, the incidence of microcytosis was substan tially greater (P = .07) in placebo-treated than iron-treated patients . Conclusions: Prophylactic oral iron supplements successfully prevent ed iron deficiency in menstruating women after Roux-en-Y gastric bypas s but did not consistently protect these women from developing anemia. On the basis of these results we now routinely recommend prophylactic iron supplements to menstruating women who have Roux-en-Y gastric byp ass.