Iron supplementation following VSG and large blood loss.

Hi All, 

Had laparoscopic VSG on 10/3/16 and dropped my hemoglobin from 14 to 6.  I received 2 units of blood, which brought my hemoglobin up to 8.8 at discharge on 10/7/16.  My team said "you're a little bit behind the 8-ball now that you are anemic." I am guessing that means that iron absorption is harder after WLS, and that getting adequate iron nutritionally is hard when you are unable to eat very much. I was advised to take a Flintstone vitamin daily. I have never required iron supplements before now. 

Has anyone had experience with treating anemia following your surgery? If Flintstone is the way to go, I have no problem doing that. If there is something more efficient and better absorbed with my new innards, I'd like to give it a try. I'd like to treat this aggressively. The fatigue from this degree of anemia is bad, and I would guess it will slow my body's efforts to recover.

I look forward to hearing your suggestions. 

Lory

I have enjoyed the Bariatric Advantage Iron chewables.  They're.. lime I think?  Although I'll be switching to the patch iron once I finish my supply.  

Personally, I wouldn't take a children's vitamin.  

You might, however, need iron infusions if your iron levels are that low.  It might be wise to talk with your PCP or a hematologist.  

I'd also recommend verifying what kind of anemia you have, as "anemia" is a catch all for when you don't have enough red blood cells - it has a lot of different causes!

Thank you, Gwen.  There is a patch for iron?!?!  I will check into the Bariatric Advantage Iron that you have been taking. 

The cause for my anemia is known--it was blood loss following surgery. Iron infusions are a last resort for me and I would only consider if I was unable to absorb any other way. Asking my Heme guy is a great idea. I did have a heme consult pre-op. Didn't even think of it. Thank you again!

Lory

My surgeon puts EVERYONE on iron supplements for life (along with multi-vitamin, extra B12, D and calcium).  And recommends a better multi-vitamin than Flintstone.  However, they don't start the regimen until 8 weeks out and enough healing has occurred.  We were told to use a chewable vitamin up to that point.

Thanks for the info, Liz. I need to check into this a little further with my dietician. I am only one week out but don't want to lose ground. There is suddenly so much to know!

Lory

I, personally, have never heard of losing such a large volume of blood during a VSG surgery. Going from a 14.0 to a 6.0 hgb is very dramatic. Did they only do the VSG on you? Did they tell you what complications they had? Did they sever an artery by mistake? An 8.0 hgb is still very low. 

Hi Kudzu, 

Yes, I only had a VSG done. Complications from surgery are rare, I understand, but when it's you, it's you. I had bleeding from the posterior staple line into my abdomen that accumulated over many hours. and was subsequently seen on CT.  I was initially stable in the recovery room and then transferred to the floor. I did not become symptomati****il 1130 at night, and the situation was not discovered until 7 the next morning. I have a large hematoma that my body is working to resorb, but I am extremely grateful that the bleeding stopped on its own and I did not need another surgery.  I agree that 8 is still low. Having not been anemic in many years, I can certainly feel the hit.  I'm hoping to find the best way to plump up my iron stores.  Without the surgery, I would know what to do; but now that my stomach is so altered, I hope to get advice from the experts here who have lived through and corrected their anemia.

Lory

I'm very sorry to hear this happened to you. As a med tech, we'd still be giving you a couple more units of packed rbc's if you were at my hospital, with an 8.0 hgb. I hope your medical team resolves this quickly for you. My prayers are with you. 

Thanks Kudzu.  I was a little surprised as well. My surgeon wanted to give me no more blood than was necessary, as he said there are risks associated with that as well. I am trusting Allah, but tethering my camel. ;)  

Hence, I am coming to the pros here for advice.

Lory

The Flintstones will do ZERO for anemia, and very little for most other things. 

Take 2 complete adult multivitamins. Either Centrum adult or a generic equivalent. Many people also need additional B12 and D3, and possibly other things.

Hemoglobin is fairly easy to bring up with iron supplements. Anything with ferrous in the ingredients, such as ferrous sulfate, will be constipating and can cause stomach upset.

Carbonyl iron is likely your best bet. I use Sundown Perfect Iron brand, but there are others.

Do not take iron within 2 hours of calcium, or things with calcium in it, such as dairy. Do not take iron within 2 hours of tea, coffee, soy, and many other things. Iron at night, right before bed, is easiest.

DO take iron with vitamin C to help absorption. 200mg of vitamin C for every 30mg of elemental iron is your best bet.

I had a bleeding ulcer last year, just after Thanksgiving. I had just had labwork done the week before. And my labs WERE really good, so I had nice reserves. But they said I had lost 6 or 7 units of blood in less than 24 hours. My blood pressure at the ER bottomed out at 58/38. Over the course of just a day, my hematocrit went from 53.2 to 21.6, and my hemoglobin from 17.3 to 7.2. My ferritin had been 364, and dropped to 24. I got a double unit of red cells in the hospital, and within a few weeks my hemoglobin and hematocrit came up pretty quickly. My ferritin has come up very, very slowly, and that's with me taking 400mg of iron per day. So, one Flintstones will do nothing. Zip.

You don't mention your ferritin. That's the most critical iron number. Did they test that? It's really, really important to check that number.