Iron Deficiency After Gastric Sleeve Surgery

Yes, iron deficiency is common after gastric sleeve surgery, though the prevalence is lower compared to Roux-en-Y gastric bypass procedures. 1

Prevalence and Risk Factors

Iron deficiency occurs in sleeve gastrectomy patients, though at lower rates than in Roux-en-Y gastric bypass (where approximately 25% of patients develop iron deficiency within 2 years) 1
Women are at significantly higher risk of developing iron deficiency after bariatric surgery, particularly those who are premenopausal 1
Patients with preoperative evidence of low iron stores are more likely to develop postoperative iron deficiency 1
Without appropriate supplementation, the prevalence of iron deficiency tends to increase over the first 10 postoperative years 1

Reduced gastric acid secretion after sleeve gastrectomy impairs the release of iron from food and conversion to absorbable forms 2
Although sleeve gastrectomy preserves the duodenum (the main site of iron absorption), alterations in gastric function can still impact iron absorption 3
Potential blood loss from anastomotic ulcers can contribute to iron deficiency 2

Regular monitoring of iron status is essential after gastric sleeve surgery 2
Recommended laboratory tests include serum ferritin, hemoglobin, and transferrin saturation 2
For patients with post-surgical iron deficiency anemia, esophagogastroduodenoscopy should be considered to exclude anastomotic ulcers 2

For prevention of iron deficiency, oral supplementation with 200-mg ferrous sulfate, 210-mg ferrous fumarate, or 300-mg ferrous gluconate daily is recommended 2
For menstruating women, double the dose (twice daily administration) to provide 100-140 mg elemental iron daily 2
Optimize absorption by taking iron with vitamin C or citrus fruits/drinks, and separating iron and calcium supplements by at least 2 hours 2
Avoid simultaneous administration with proton pump inhibitors when possible 2

Long-term oral iron replacement therapy is often effective for sleeve gastrectomy patients 1
However, due to underlying malabsorption, some patients may require intravenous iron therapy 1, 4
Intravenous iron is particularly indicated in cases of severe iron deficiency anemia, poor response to oral supplementation, or after malabsorptive procedures 2
Options for intravenous iron include low-molecular-weight iron dextran, iron sucrose, ferumoxytol, and ferric carboxymaltose 2

Standard multivitamin and mineral supplements alone are typically insufficient to prevent iron deficiency after bariatric surgery 2
Iron deficiency can significantly impair quality of life even before anemia develops 2
In new presentations of iron deficiency anemia after gastric sleeve, other causes should still be considered and excluded, particularly in those at risk of GI malignancy 1
The American Gastroenterological Association recommends intravenous iron as the preferred treatment for iron deficiency in patients after bariatric surgery, particularly in severe cases or when oral supplementation is ineffective 2