Prevalence of iron deficiency anaemia in patients of cholelithiasis undergoing laparoscopic cholecystectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20221721Keywords:
Laparoscopic cholecystectomy, Iron deficiency anaemia, Gall stones, AnaemiaAbstract
Background: Gallstone disease (GSD) is a very common condition worldwide and the key event in the cholesterol stone formation is the supersaturation of bile with cholesterol. The role of trace elements like iron, calcium has been suggested in the pathogenesis of gallstones. Both iron deficiency and GSD are more prevalent in India. With this background, we studied the frequency of iron deficiency anaemia in GSD patients.
Methods: This prospective observational study enrolled 150 adult patients undergoing laparoscopic cholecystectomy for symptomatic GSD in a north-Indian tertiary care hospital. Complete hemogram, serum ferritin, iron and unbound iron-binding capacity (TIBC) were performed in all patients. To simplify interpretation, anaemia was defined as Hb <12 gm/dl; iron deficiency was defined as either ferritin value lower than the reference range, or, if the ferritin was within the reference range, reduced % transferrin saturation with normal-or-high TIBC.
Results: Anaemia was present in 66% and 77.3% were having iron deficiency; of which 84.5% were females. Iron deficiency with anaemia was present in 85.3%; therefore remaining patients had latent iron deficiency. Serum ferritin was normal or raised in 52 (68.1%) patients with iron deficiency, indicating that it is insensitive as a stand-alone test for iron deficiency.
Conclusions: At a public health level, our results may suggest that addressing the problem of endemic iron deficiency may also reduce the possible development of GSD in the community. Thus, pre-operative assessment of iron status appears to be a cautious choice in all patients planned for cholecystectomy as indirectly it will address the problem of anaemia in the population.
References
Tandon RK. Prevalence and type of biliary stones in India. World J Gastroenterol. 2000;6(3):4-5.
Cariati A. Gallstone Classification in Western Countries. Indian J Surg. 2015;77(2):376-80.
Unisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK. Population‐based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural Gangetic basin of North India. HPB. 2011;13(2):117-25.
Dowling RH. Pathogenesis of gallstones. Aliment Pharmacol Ther. 2000;14(s2):39-47.
Carey MC. Pathogenesis of gallstones. Am J Surg. 1993;165(4):410-9.
Johnston SM, Murray KP, Martin SA, Foxtalbot K, Lipsett PA, Pitt HA. Iron deficiency enhances cholesterol gallstone formation. Surgery. 1997;122(2):354-61.
Misra PK, Kumawat S, Kharb S. Role of trace elements in the formation of gall stones. Asian J Biochem. 2014; 9:213-20.
Prasad PC, Gupta S. To study serum iron levels in patients of gall bladder stone disease and to compare with healthy individuals. Indian J Surg. 2015;77(1):19-22.
Dadhich Y, Bhardwaj G, Goel G, Mandia R. Correlation of serum iron and ferritin levels in patients of cholelithiasis and comparison with healthy individuals. Int J Surg. 2019;6(6):1981-6.
Goldblatt MI, Swartz-Basile DA, Choi SH, Rafiee P, Nakeeb A. Iron deficiency transiently suppresses biliary neuronal nitric oxide synthase. J Surg Res. 2001;98(2):123-8.
Swartz-Basile DA, Goldblatt MI, Blaser C, Decker PA, Ahrendt SA, Sarna SK. Iron Deficiency Diminishes Gallbladder Neuronal Nitric Oxide Synthase. J Surg Res. 2000;90(1):26-31.
Salomons H, Keaveny AP, Henihan R, Offner G, Sengupta A, Lamorte WW, Afdhal NH. Nitric oxide and gallbladder motility in prairie dogs. Am J Physiol. 1997;272:G770-8.
Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19(92):164-74.
Kumari R, Raushan KB, Singh K, Sinha A, Kumar S. Prevalence of Iron Deficiency and Iron Deficiency Anaemia in Adolescent Girls in a Tertiary Care Hospital. J Clin Diagn Res. 2017;11(8):4-6.
Peng YY, Uprichard J. Ferritin and iron studies in anaemia and chronic disease. Ann Clin Biochem. 2017;54:43-8.
Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anaemia in the 21st century. Therap Adv Gastroenterol. 2011;4(3):177-84.
Rai RK, Fawzi WW, Barik A, Chowdhury A. The burden of iron-deficiency anaemia among women in India: how have iron and folic acid interventions fared? WHO South East Asia J Public Health. 2018;7(1):18-23.
Al-Mulhim AS. Laparoscopic cholecystectomy in anemia patients: a retrospective cohort study. International Surgery Journal. 2018;5(2):643-6.
