Anemia in Pediatric Inflammatory Bowel Disease

A recent retrospective study (G Aljomah et al. JPGN 2018; 67: 351-5) provides some useful information about anemia in the pediatric inflammatory bowel disease (IBD) population. This study included 153 patients, though the diagnostic tests varied considerably; for example, only 42 patients had a serum transferrin receptor (sTR) assay available at followup.

Key points:

  • 67.3% of patients had anemia at diagnosis.  38.5% had anemia of chronic disease (ACD) and the remainder had either iron deficiency anemia (IDA) or IDA in combination with ACD.
  • 20.5% had anemia at followup approximately 1 year after diagnosis. 5.1% with ACD alone and 15.4% had IDA or IDA in combination with ACD.
  • In a subset of patients with more complete data, it was shown that anemia was much more common in patients with Crohn’s disease: 91.2% at diagnosis and 27.3% at followup compared with patients with ulcerative colitis with 40.0% at diagnosis and 7.7% at followup.

The authors used the sTR index (sTR/log ferritin index) to determine if ACD was present.  “This index can differentiate IDA from ACD; however, it cannot separate IDA from the combination of IDA/ACD.  IDA or IDA/ACD were considered to be present if the sTR index was greater than 1.03. An sTR index of <1.03 was taken to be indicative of the presence of ACD.”

Briefly noted: MR Serpico et al. JPGN 2018; 67: 341-5.  This retrospective study  examined the use of allopurinol to optimize thiopurine levels.  32 of 52 patients remained on the combination for 1 year.  In this group, median alanine transaminase decreased to 19 from 77 (P<0.001) and median 6-TG levels increased to 322 from 166 (P<0.001). In addition, steroid-free remission rates improved to 82% (23 of 28).  About 40% of the initial cohort of 52 patients were switched to antitumor necrosis factor therapy.

My take: The initial study shows that anemia is frequent in pediatric IBD, especially at diagnosis (67%).  Even at followup, 20% of patients had ongoing anemia.

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