Iron Deficiency question......

I also have a great GP that knows very little about post bariatric surgery. She will order any of the blood tests I ask for and helps me to monitor the trends.

Someone shared this list with me early on so I use it to make my requests to my GP, plus A1C.

Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose, BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase)

Pre?albumin:
Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

Hep panel: includes ALT (SPGT) & GGT)
Phosphorous - Inorganic:
Magnesium:
Uric Acid:
Thyroid panel: (T3U, T4, FTI, TSH)

Hemogram with platelets:
Iron: TIBC, % sat
Ferritin:
Zinc:
Vitamin A:
Vitamin D: (25?hydroxy)
Vitamin B?1: (Thiamin)
Vitamin B?6: (Pyridoxine)
Vitamin B?12 & Folate:
Serum intact: PTH
Osteocalcin:
Vitamin K:
PT:
PTT:

Wow, this is so helpful! I have an appointment with him next Friday on the 5th of Aug. I will brings this list and make sure he puts into my standing lab order.

So, I am gonna see my PCP on the 5th, talk about the two infusions that are now scheduled for the 12th and the 19th and go from there.

Thank you very much, Jen.....

Jeff W Waldrop

I am 16 yo out as well and a few years ago after an illness, became severly anemic. To summarize: I was unable to absorb the iron from pill/capsule form, and this is part of the permanent effects of bariatric surgery. My cardiologist, who is most aware, was not thrilled about the infusions if avoidabloe, because of the steriod use and interaction with diabetes. The solution: liquid iron, taken 3 times weekly. I take it with some apple cider vinegar, since iron absorbs best in an acidic environment. Started with daily dose, but reduced when I became no longer anemic. Not tasty, but the least invasive and least expensive solution, and no appointments either!

Good luck. Of course your doctor may not be informed. With all the time we long timers have worked, we know more than we realize.

Let us know what type of Iron infusions they want to give to you. Some can have long term side effects.

Feraheme ? Feraheme® (ferumoxytol injection)

It has a posted Black Box Warning (I have never heard that term before, but I know what it means now....)

These are the warnings from their Website:

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Warnings and Precautions

Hypersensitivity: In addition to the fatal and serious adverse reactions in the Boxed Warning, other adverse reactions associated with hypersensitivity have occurred (pruritus, rash, urticaria, and wheezing). Allergic reactions have occurred following the first dose or subsequent doses in patients in whom a previous dose was tolerated. Patients with a history of multiple drug allergies may have a greater risk of anaphylaxis with parenteral iron products. Carefully consider the potential risks and benefits before administering Feraheme to these patients. Elderly patients with multiple or serious co-morbidities who experience hypersensitivity reactions and/or hypotension following administration of Feraheme may have more severe outcomes.

Hypotension: Feraheme may cause clinically significant hypotension. Monitor patients for signs and symptoms of hypotension following each Feraheme administration.

Iron Overload: Excessive therapy with parenteral iron can lead to excess storage of iron with the possibility of iatrogenic hemosiderosis. Regularly monitor the hematologic response during parenteral iron therapy. Do not administer Feraheme to patients with iron overload.

Magnetic Resonance (MR) Imaging Test Interference: Administration of Feraheme may transiently affect the diagnostic ability of MR imaging. Alteration of MR imaging studies may persist for up to 3 months following the last Feraheme dose. Maximum alteration of vascular MR imaging is anticipated to be evident for 1 ? 2 days following Feraheme administration.

Adverse Reactions

The most common adverse reactions (? 2%) are diarrhea, headache, nausea, dizziness, hypotension, constipation, and peripheral edema.

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Jeff W Waldrop

Most iron IV have black box warnings.

But feraheme is known to induce low to very low phosphorus. Some docs, including my current gastro doc, stop recommending them.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152545/

https://www.robinskaplan.com/resources/publications/2020/07/ injectafer-linked-to-severe-hypophosphatemia

Just make sure you get the phosphorus checked 1 month after that. Then 2 months after. Insist on that.

My phosphorus is always really high....so I am pretty sure the infusions did not impact (before and after infusions).

Also, it sounds like folks post surgery are primarily followed by PCP and not by their surgeons office? I just contact the office where I had my WLS surgery done yearly and they request all the blood tests they want and then I set up an appointment to go over the results with them. My PCP may also comment on the lab results, for example on high cholestral. And i check out my results every year. My medical provider has 'mychart' and it does a graph of my results for each finding, which can be helpful and also says what the normal range is.

I think it depends on the practice and the individual. I moved states or would still be seen at my practice but since I found a PCP local that would do what I wanted it works for me. There are people here many years out that still go to their practice and their PCPs are just for regular, non WLS issues. Key is finding what works for you, I guess, just like everything else!

I had the infusiona for about a year, 7 years out from my surgey and it helped so much...I would say the effects lasted about 3 years.

My current lab work shows I need them again.

I had similiar issue around 8-10 years out (but I do think it was related to PC telling me to cut back on multi) I did end up with the 2 infusions....however that was years ago now and I track every year and it has been over 6 years and I still don't need another transfusion. I had RNY. The infusions were easy and very helpful, However very spendy on my insurance at the time. Now they would be covered. I had no problems with the influsions...totally reccomend....but would suggest you check out the cost. If I recall I paid like 1K out of pocket for each....I remember being shocked. I have iron in my mult now....but the numbers do go down every year.