Unrecognized anemia after whipple – should we learn from gastric bypass?

ABSTRACT

Introduction

Several pathophysiologic changes after the Whipple procedure have been well described, but anemia has not. Post-surgical changes can impede micronutrient absorption. We hypothesize that patients post-pancreatoduodenectomy suffer from iron deficiency anemia.

Methods

Patients who underwent a pancreatoduodenectomy from 2016 to 2018 were retrospectively evaluated. Preoperative, intraoperative, and postoperative data, including hemoglobin (Hb) levels and mean corpuscular volume (MCV) as well as therapies with chemoradiation, iron, and/or B12 were collected at 1-, 3-, 6-, and 12-months after surgery.

Results

The dataset included 74 patients (median age: 64 years). Mean preoperative Hb and MCV were 11.7 ± 1.9 g/dl and 90.1 ± 7.3 fl, respectively. Significant changes in Hb were noted at 1 and 6 months (11.7 vs 10.9, p = 0.01 and 11.7 vs 11.3, p = 0.003, respectively), and in MCV were noted at 6 and 12 months (90.1 vs 94.6, p = 0.008 and 90.1 vs. 93.7, p = 0.02, respectively).

Conclusions

All patients remained anemic after pancreatoduodenectomy. This was not linked to chemotherapy. Iron and vitamin B12 supplementation, given in a minority, did not ameliorate the anemia. Future studies should investigate this lack of aid, as nutrient supplementation may be an important change in the standard of care of these patients.

KEYWORDS:

• Anemia
• bariatric
• iron
• pancreaticoduodenectomy
• whipple procedure

Author contributions

Dr. Terence Jackson: design of project, data analysis, paper revising

Dr. Shyam Vedantam: drafting of paper, chart review and data collection, paper revising, literature review

Dr. Rhiannon Bradshaw: data analysis

Dr. Edward Cho: data collection, paper revising

Dr. Joseph Lim: data collection, paper revising

Dr. Kei Nagatomo: data collection, paper revising

Dr. Houssam Osman: data collection, paper revising

Dr. Rohan Jeyarajah: conception and design of project, paper revising, final approval of version to be published

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

The authors report no grants, fellowships, commercial assistance, or financial sponsorship was received for this research. This paper was not funded.