Potential Hematology and Nutritional Complications of Bariatric Surgery

Abstract

Bariatrics is a specialized field of medicine that deals with the etiology, prevention and management of patients with morbid obesity. Surgical and nutritional complications are two adverse effects associated with bariatric surgery. For patients in recovery, post-bariatric surgical treatment and management often involves the care of a hematologist. Long term nutritional problems may develop following bariatic surgery and should be considered by physicians, although long-term nutritional complications are often rare or just temporary. Multivitamin and iron supplementation are required as part of a patient's prophylactic postbariatric surgical management protocol; therefore, the patient's adherence to vitamin supplementation should be checked during follow up appointments. This review aims to emphasize the potential multi systemic hematological and nutritional complications of bariatric surgery. Vitamin deficiencies such as iron and vitamin B12 sometimes affect patients and therefore physicians should be aware of this in the treatment of patients with a history bariatric surgery. Inquiring about a patient's history of bariatric surgery needs to be one of the first questions to ask a patient who is presenting with vitamin deficiencies as this can cause multi system abnormalities. Many patients are lost to follow up after bariatric surgery and come back with complications. Therefore, the importance of maintaining follow up appointments should be emphasized.

Bariatric Surgery Impact on Sickle Cell Disease Pain Crisis: A Case Report

“…After BS, patients usually develop H. Al-Jafar et al [11]. A few months or few years after BS, the patients become deficient in micronutrients and trace elements including water, fat-soluble elements such as iron, calcium, phosphorus, copper, magnesium, selenium, chromium, and zinc [12], as well as vitamins such as thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folate, cobalamin and vitamins B, D, C, E, K. These nutrients and elements work as enzymatic cofactors in several metabolic processes and biochemical reactions. Therefore, BS can cause a wide range of nutritional, systemic, and psychiatric complications [13].…”

“…The specific risk for developing micronutrient and protein deficiencies cannot be predicted as there is no consensus on the amount of vitamin and mineral supplementation required after BS. However, it is clear that micronutrient deficiencies are relatively common in patients after all types of BS, and so, it is important to screen them before and periodically after the surgery for micronutrients and trace elements [12]. For any type of surgery, SCD patients need special hematological recommendations for maintaining adequate blood level, oxygen saturation, and proper hydration before and after the surgery [16].…”

Postoperative Osteoporosis in Subjects with Morbid Obesity Undergoing Bariatric Surgery with Gastric Bypass or Sleeve Gastrectomy

“…Today, postoperative vitamin B 12 supplementation is routinely recommended following bariatric surgery [ 47 ]. Folic acid deficiency (vitamin B 9 ) is also reported after bariatric surgery [ 48 , 49 ]. Notably, folate deficiency has been associated with reduced bone health due to disturbed collagen crosslinking [ 50 ].…”