Management of inflammatory bowel disease-related anemia and iron deficiency with specific reference to the role of intravenous iron in current practice

Background. Anemia is common in inflammatory bowel disease (IBD). Oral iron is widely used but efficacy can be reduced by poor compliance and insufficient absorption. Intravenous iron is safe and effective in adults but is not well studied in children. Purpose. To assess safety and efficacy of intravenous iron sucrose (IVIS) in children with IBD. Methods. We reviewed medical records of IBD patients <22 years of age who received IVIS at our institution between 2009 and 2014. Anemia was defined as hemoglobin (Hgb) level below normal for age and gender and iron-deficiency anemia as serum iron studies and red cell mean corpuscular volume below normal ranges. Each IVIS infusion was evaluated for safety. Efficacy was defined as ≥2 g/dL increase in Hgb ≤12 weeks from IVIS initiation. Results. We identified 88 patients (Crohn’s disease, n = 52; ulcerative colitis, n = 33; IBD-unclassified, n = 3) who underwent 329 IVIS infusions over 121 courses. No patient developed anaphylaxis. Six patients developed minor adverse reactions. Of the 121 IVIS courses, 80 were included in the efficacy evaluation. There was a significant rise in Hgb (mean 9.1 ±1.4 to 11.9 ± 1.8 g/dL; P < .0001, paired t test). Overall, 58.7% (47/80 courses) resulted in goal Hgb increase. Conclusions. IVIS is safe and effective in treating iron-deficiency anemia in pediatric IBD. There were only minor adverse events, and the observed rise in Hgb was clinically significant, with the majority achieving goal Hgb.

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The efficacy of intravenous iron therapy in patients with inflammatory bowel disease associated iron deficiency anemia is not influenced by the degree of inflammatory activation

Zeitschrift für Gastroenterologie ◽

10.1055/s-0031-1285368 ◽

2011 ◽

Vol 49 (08) ◽

Author(s):

J Kunath ◽

A Dignass ◽

S Vollmer ◽

W Klemm ◽

S Weber-Mangal ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Bowel Disease ◽

Intravenous Iron ◽

Iron Therapy ◽

Deficiency Anemia ◽

Inflammatory Activation ◽

Inflammatory Bowel ◽

Intravenous Iron Therapy

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Management of Iron Deficiency Anaemia in Inflammatory Bowel Disease

Acta Haematologica ◽

10.1159/000496728 ◽

2019 ◽

Vol 142 (1) ◽

pp. 30-36 ◽

Cited By ~ 3

Author(s):

Kristine Michelle Jimenez ◽

Christoph Gasche

Keyword(s):

Inflammatory Bowel Disease ◽

Iron Deficiency ◽

Bowel Disease ◽

Iron Deficiency Anaemia ◽

Intravenous Iron ◽

Extraintestinal Manifestation ◽

Deficiency Anaemia ◽

Multiple Parameters ◽

Inflammatory Bowel ◽

Selection Of

Inflammatory bowel disease (IBD) is a group of chronic relapsing inflammatory disorders affecting the large and small intestine, with a rising worldwide incidence and prevalence. Anaemia is the most common extraintestinal manifestation of IBD, correlating with disease activity, and tending to relapse even after successful therapy. Iron deficiency is the most common cause; however, it often manifests in combination with anaemia of inflammation. As such, multiple parameters are used for the diagnosis of iron deficiency anaemia in IBD. Timely recognition and selection of appropriate therapy leads to an improvement in the quality of life and prevention of potential sequelae. Oral iron can be effective under specific circumstances; however, as luminal iron changes microbiota and bacterial metabolism, oral administration should be avoided. Intravenous iron is preferred as it bypasses the sites of inflammation. Nevertheless, the optimization of IBD treatment should occur simultaneously, as this improves both patient condition and response to iron therapy. Herein, we discuss the screening, diagnosis, selection of therapy, and follow-up for iron deficiency anaemia in IBD.

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