Q: More than 10 years back, I underwent duodenal ulcer operation. A part of the duodenum, which decayed, had to be cut off by the surgeon. Since then I have turned anaemic. My haemoglobin level, which was initially 15 fell to as low as 5.5 to 6.5. Though I am not feeling tired, I do feel weak. Iron injections have helped to take the level up to 8 only. Will folic acid substitutes help? Even blood transfusion can take it up by 2 points, which again is temporary. Is there any permanent solution to this? There are no other related issues like blood going out in faeces, etc. Can you please help me?

A:Nutrient deficiencies are common following duodenal surgery, as the body doesn't absorb iron, calcium and other nutrients efficiently following surgery. Fortunately, these deficiencies can usually be controlled with proper diet and vitamin supplements (Folic acid and vitamin B12). Iron deficiency anaemia results due to impaired iron absorption. Ferritin (measure of iron stores) or iron levels and erythrocyte counts need to be monitored, as iron stores may continuously decline up to 7 years after surgery. Simply correcting the haemoglobin is not sufficient and an adequate iron status is imperative. There are no strict guidelines, although serum ferritin should be kept between 400 and 1000 mg/L. It is very difficult for iron-deficient patients to absorb sufficient oral iron. Intramuscular iron can be impractical over the long run. Intravenous iron dextran or iron sucrose needs to be given regularly upto several times a year. This can be done as an outpatient procedure and is well tolerated by patients. Serum ferritin and transferrin saturation (above 20% at least) should only be checked 1 month after each iron dose and, once stable, every 3 months.