Postresectional anemia. A preventable complication of total gastrectomy
E. L. Bradley and J. Isaacs
The incidence of anemia after total gastrectomy has not received sufficient
clinical emphasis. During a follow-up period averaging 32 months,
postresectional anemia developed in seven of ten patients without evidence
of malignant neoplasm; all but one of these patients had received
parenterally administered cyanocobalamin. Despite low levels of circulating
erythrocytes and proportionately increased erythropoietin levels,
reticulocytosis was not evident. This observation suggests an
uncharacterized failure of marrow erythyroid precursors. Multiple deficits
in intake of constituents necessary for the production of erythrocytes were
demonstrated. With the possible exception of iron, malabsorption of these
constituents is not an important factor in the production of anemia.
Postresectional anemia is multicausal, but is primarily nutritional. As
total gastrectomy becomes more commonly employed in the treatment of
nonmalignant conditions, recognition of the frequency and causes of
postresectional anemia should assist both diagnostic anticipation and
therapy.
