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As weight loss begins to slow down after gastric bypass, the risk of nutritional problems increases. This is due to dysfunctional or bypassed small bowel. B12 and iron deficiency are two of the most common problems and often do not respond to typical multivitamin supplementation. Iron deficiency after gastric bypass is usually only seen in menstruating women or in patients who are actively and chronically bleeding. Ferritin or iron levels and erythrocyte

As IV iron preparation have become safer, they are increasingly being used. However, the oral route is still best, when possible. Ferraheme is the latest IV iron entrant. Feraheme™ (ferumoxytol) Injection is indicated for the treatment of iron deficiency anemia in adult patients with chronic kidney disease (CKD). There are four commercially available i.v. iron products, iron dextran, iron sucrose, and iron ferric gluconate, or Ferrlecit and Ferraheme.

Current understanding of hemachormatosis incorporates the fact that some 30% of patients with familial occurrence of iron overload associated with C282Y homozygosity or C282Y/H63D compound heterozygosity never develop symptoms of the disease and this number is higher in menstruating females. It is also now appreciated that this is a disease with a long horizon before organ damage occurs and that close followup makes immediate diagnosis unnecessary