By Jeffrey Paonessa, MD

To maintain wellness, we want our BCIR alumni and their health care team to be aware of the possibility of anemia.  The two major etiologies of anemia in this patient population are related to low iron stores and vitamin B12.  Early diagnosis and prompt treatment can limit the severity of these conditions.

Each time you intubate your pouch, microscopic blood is lost.  In time, the cumulative effect can catch up with you with the symptoms of weakness and fatigue.  In more severe cases one can complain of shortness of breath and dizziness.

It is our recommendation that your primary care physician monitor your complete blood count (CBC) annually and ferritin level every three or four months as a standard blood test.  Although a normal ferritin level varies from each lab, we would like you to stay on the upper spectrum of the grid.  We suggest intravenous iron infusions when and if the trend is decreasing.

Do not wait for the level to drop into double digits before you seek intervention.  The suggested dose of intravenous iron is 500mg at a session.  Usually a hematologist is the specialist who would administer the intravenous iron in an outpatient setting.  Once your iron stores are normal, continue to have your ferritin levels followed every 4 months and react accordingly.  The goal is to be proactive and not reactive.  We do not suggest oral iron to treat anemia as the absorbency is questionable and it is difficult on the stomach.

Vitamin B12 is essential for normal nervous system function and blood cell production.  There are several causes for this type of deficiency but one is intestinal surgery that may affect absorption.  Therefore it is our desire for you to get a B12 level at least twice a year.  Treatment would be vitamin B12 injections until the condition improves.