Question:
Has anyone else ever become anemic after LBL and lipo?

I had my LBL with extensive lipo on 11/1. I had my blood count checked 4 weeks later and it showed iron def anemia so I started iron tablets, well 1 month later it is lower then before the iron. I have a lot of swelling still, hard and I am soooooooooo itchy. PS said it was lymphatic banding and it will ease as time goes on. Just wondering if this has happened to anyone else. Wendy    — Wendy H. (posted on December 24, 2004)

December 23, 2004
Dear Wendy, It is very common to be anemic after a lower body lift. The operation usually lasts over 6 hours and it is common to lose a moderate amount of blood. Iron tablets will help, but it may take 2-3 months before your blood count is restored to your pre-op level. It is also important to take Vitamin C and a multivitamin. I hope this information is useful to you and happy holidays! Joshua Kreithen, M.D. - Lakewood Ranch Plastic Surgery, Bradenton FL - www.lakewoodranchplasticsurgery.com
   — Joshua Kreithen, M.D.

December 24, 2004
Hi Wendy, Not an uncommon occurance after any surgery but especially in a WLS patient. We have a hard time absorbing iron, assuming you are a RNY, so once it goes down it is hard to get it back up. Make sure you are taking one of the absorbable irons like Ferrous Fumarate. There are a couple of others we absorb fairly well also, but Ferrous Sulfate, which is what my PS put me on, we do not absorb. <p>I lost almost 5 units of blood during my LBL. It was just short of 11 hours of surgery and the doc had also decided to use a blood thinner to alleviate clots. This was at the urging of my WL surgeon. Because I was still over 200 lbs, 217, he was concerned of clotting developing but he also knew the risks of losing too much blood. It was a 50/50 shot as to which way to go. I do not feel he did anything wrong. Given the chance, I would have chosen the blood thinners because that's easier to deal with than clots. My hemoglobin went down to 8.3 and that was after receiving one unit of blood. After 2 more units it got up to 9.6 before I left the hospital. It eventually settled out in the mid 10's, which is still anemic. Since I got so constipated from the iron pills I just stopped taking them. I actually did not feel tired or anything, so I would never have known I was anemic. I went into my 2nd surgery in the 10 range and dropped into the 9's but it settled out in the 10's again. 3 months after the 2nd PS my internist ordered iron infusions. I had them 4 days in a row and 6 weeks later when I had to donate blood for my 3rd PS it was 12.6, so the infusions worked. Now I'm back to 10.3 due to the last surgery. This time I am taking the Ferrous Fumarate and having less constipation problems with it than the Ferrous Sulfate, so I have been better able to comply with taking it. My internist wanted to do infusions again but I said I wanted to wait until my next blood work in 3 months to see if I cannot bring it up with the pills and eating some iron rich foods. If that doesn't do it then I will agree to the infusions again. They aren't a big deal but it's like 4-5 hours for 4 days in a row and a cost of $1000 per day. Even though my insurance fully covers, it kills me to spend that kind of money for a bag of saline, 250ml of iron and a bed to plop my butt in. Oh and I cannot forget the "wonderful" sandwiches they gave me. <p>I am 6-1/2 weeks PO from my medial thigh lift and significant redo of the upper torso. I still have some itching but it has pretty well subsided. I know what you mean though. When the itching is at it's worst you just cannot get enough of it. As far as swelling it was a good 2 months before I dropped a size in pants and about 6 months before I dropped 2 sizes. All I can tell you is it just keeps getting better. Hang in there and keep after the anemia. You may also be forced to go the infusion route. It's more of an inconvenience than anything. I'm just glad there IS something available to help us WLS patients. I was never anemic in my life, even after 9 months of solid moderate to heavy bleeding when I let the docs mess around with BCP's to try and get my body to behave. So my tendency certainly wasn't toward the anemic side before WLS. I'm hopeful that if I do need infusions again that my body will at least be able to maintain the level it achieves. Good Luck!
   — zoedogcbr

December 24, 2004
wendy, i need two units after surgery .i started taken chlorophyl 3x a day after that because i refused anymore blood. it comes in tablets or liquid and you can get it at the health food store.you will notice an improvment in less then a week.All the Best! Tracey
   — traceybubbles

December 26, 2004
Wendy - I was anemic after LBL. My PCP put me on iron for 3 weeks. I just had 6 month lab work done and everything came out normal. You'll be fine.
   — [Deactivated Member]

December 26, 2004
Wendy, has anyone been including ferritin in your lab work since your RNY? My bariatric surgeon didn't. I learned from the Yahoo Grads list that declining ferritin, which is a measure of iron stores, can be an early indicator of impending anemia in RNY patients, and that it can occur anytime but that it often seens to occur at around the two-year post-op mark.<P>So, I had my pcp add ferritin to my labwork (which all my doctors thought was silly because all other iron indicators looked fine to them). Sure enough, I had a very low ferritin level though the other iron indicators they'd been tracking still looked find. My bariatric surgeon's partner flatly refused to increase my prescription iron based solely on the low ferritin reading, so I moved my post-op care to my endocronologist. He doubled the Trinsicon (prescription iron) I was on. I've made no progress in raising that or other iron levels even on doubled prescription iron in the past several months, but at least nothing's getting worse. And during that time I also had an LBL, so maybe I avoided post-PS anemia by doubling my iron supps., I dunno. Your story makes me think maybe I got lucky there.<P>There's some anecdotal experience on the Grads list to the effect that some WLS post-ops with malabsorption surgeries begin to develop impending signs of anemia at around the two-year post-op mark. During my "google" efforts on this issue, I even found a reference to one study of patients in which this had been observed as true. Unfortunately, too few docs seem to know about it, or why it's important to watch ferritin levels so it can be identified *before* the patient is flat-out anemic.<P>As Chris D. said, it can be hard to bring up your iron levels with iron supplements alone -- in my own experience, *very* hard, and I'm only a proximal RNY. In your shoes, I might search for a hematologist who understands the wrinkles involved in bringing iron back up to normal levels with any RNY patient, for you may need an iron infusion to do so. But unless you have a very good PS, he may not be aware of how hard this can be to address in some RNY post-ops at your stage, versus PS post-ops in general.
   — Suzy C.

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