Postresectional anemia. A preventable complication of total gastrectomy

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.