In some patients with inflammatory bowel disease (IBD), treatment of anemia associated with IBD sometimes results in more symptomatic benefit than treatment of the IBD. Yet, anemia remains common in IBD, both in children and adults (Inflamm Bowel Dis 2012; 18: 513-19).
Using a cross-sectional observational study design, a tertiary adult and pediatric IBD center reviewed consecutive clinic patients in April 2009. The prevalence of anemia was 70% (41/59) children, 42% (24/54) adolescents, and 40% (49/124) adult. In addition, iron deficiency anemia was more common in the pediatric population: 36/41 children and 20/23 adolescents. In the adults with anemia, only 55% (27/49) were iron deficient. One of the key determinants of anemia was disease activity.
Interestingly, among patients with iron deficiency, younger age was inversely associated with treatment with iron therapy: 13% of children, 30% of adolescents, and 48% of adults.
Other important aspects of anemia in IBD:
- Anemic patients can have quality of life scores as poor as those seen in malignancy
- Almost all IBD patients will respond to either oral or parenteral iron. Erythropoetin reserved for patients who do not respond to parenteral iron.
- -NEJM 2005; 352: 1011. Anemia algorithm. If transferrin saturation <16%, check ferritin. If ferritin less than 30, then patient with Fe-deficiency; if >100, anemia of chronic disease. If 30-100, could check soluble transferrin receptor (level of sTranReceptor/log ferritin < 1 is c/w anemia of chronic disease whereas when > 2, c/w combined Fe-def anemia and anemia of chronic disease)
- -JPGN 2010; 51: 708. 25-50% still anemic 1yr post IBD diagnosis.
- -IBD 2007; 13: 1545-53. Guidelines for anemia mgt w IBD. Max oral absorption is 10-20mg/day; thus IV iron often needed. Goal for iron Rx is transferrin saturation of 15-50% and ferritin > 30 mcg/L (>100 if active inflammation). Anemia of chronic disease likely if TS <16% and ferritin > 100. Rec IV iron Rx prior to use of Epo. IV iron effective alone in 70-80%. Epo if no response to IV iron & Hgb <10. Consider folic acid & B12 deficiency if high MCV. AZA/6MP usually associated with pancytopenia not isolated anemia.
- -Gastroenterology 2011; 141: 846. Ferric carboxymaltose better than iron sucrose (Ferrlecit/Venofer) b/c can use higher dose & give more rapidly.