Refractory and persistent iron deficiency anemia after bariatric surgery: investigation of both mutations 1285g-c and 1246c-t in the SLC11A2 gene

Abstract

The global obesity pandemic has alarming psychological, health and socioeconomic implications. The surgical treatment of obesity has been consecrated as the main alternative for weight control, with Roux-en-Y gastric bypass being one of the most widespread techniques. But, the clinical follow-up post-bariatric surgery has shown a tendency to hematological changes, especially chronic anemia, and nutritional. Although iron deficiency is a prominent cause of anemia in obese patients after bariatric surgery, it is not responsible in all cases. If anemia is persistent and does not respond to iron supplementation therapy, additional deficiencies of micronutrients and other sources of anemia should be considered by supplementary investigation of serum levels of folic acid, vitamins B12, A and E, zinc and copper. As there are still a significant number of anemias that remain unexplained after surgery, the hypothesis of genetic alterations involved in iron metabolism should be considered, with molecular investigation in addition to hematological and metabolic parameters. Thus, among the mutations identified in the SLC11A2 gene, which encodes the DMT-1 protein, two were more associated with a clinical condition of microcytic hypochromic anemia, due to changes in protein conformation. Therefore, the aim is to investigate the association of both mutations 1285G-C and 1246C-T in the SLC11A2 gene and the etiopathogenesis of persistent anemia and refractory to iron supplementation in patients of both sexes, in the age range of 16 to 65 years, undergoing Roux-en-Y gastric bypass bariatric surgery from 2010 to 2017, and that they are clinical followed up for more than a year. (AU)