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Management of Anemia in Patients with Inflammatory Bowel Disease (IBD)

  • Inflammatory Bowel Disease (G Lichtenstein, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of Review

Anemia is the most common complication as well as an extra intestinal manifestation of inflammatory bowel disease (IBD). It is associated with a significant impact on patient’s quality of life (QoL); as well it represents a common cause of frequent hospitalization, delay of hospital inpatient discharge and overall increased healthcare burden. In spite of all these, anemia is still often underdiagnosed and undertreated. Our aim in this review is to provide a pathway for physicians to help them achieve early diagnosis as well as timely and appropriate treatment of anemia which in turn would hopefully reduce the prevalence and subsequent complications of this condition among IBD patients.

Recent Findings

The etiology of anemia among IBD patients is most commonly due to iron deficiency anemia (IDA) followed by anemia of chronic disease. Despite this, more than a third of anemic ulcerative colitis (UC) patients are not tested for IDA and among those tested and diagnosed with IDA, a quarter are not treated with iron replacement therapy. A new algorithm has been validated to predict who will develop moderate to severe anemia at the time of UC diagnosis. While oral iron is effective for the treatment of mild iron deficiency-related anemia, the absorption of iron is influenced by chronic inflammatory states as a consequence of the presence of elevated levels of hepcidin. Also, it is important to recognize that ferritin is elevated in chronic inflammatory states and among patients with active IBD, ferritin levels less than 100 are considered to be diagnostic of iron deficiency. Newer formulations of intra-venous (IV) iron have a good safety profile and can be used for replenishment of iron stores and prevention of iron deficiency in the future.

Summary

Routine screening for anemia is important among patients with IBD. The cornerstone for the accurate management of anemia in IBD patients lies in accurately diagnosing the type of anemia. All IBD patients with IDA should be considered appropriate for therapy with iron supplementation whereas IV administration of iron is recommended in patients with clinically active IBD, or for patients who are previously intolerant to oral iron, with hemoglobin levels below 10 g/dL, and in patients who need erythropoiesis-stimulating agents (ESAs). As the recurrence of anemia is common after resolution, the monitoring for recurrent anemia is equally important during the course of therapy.

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Authors and Affiliations

  1. Section of Gastroenterology, Drexel University College of Medicine, Philadelphia, PA, USA

    Dhruvan Patel MD

  2. Section of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Chinmay Trivedi MBBS & Nabeel Khan MD

  3. Section of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Nabeel Khan MD

  4. 3900 Woodland Avenue, Philadelphia, PA, 19104, USA

    Nabeel Khan MD

Authors
  1. Dhruvan Patel MD
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  2. Chinmay Trivedi MBBS
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  3. Nabeel Khan MD
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Correspondence to Nabeel Khan MD.

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Dhruvan Patel declares that he has no conflict of interest. Chinmay Trivedi declares that he has no conflict of interest. Nabeel Khan declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Inflammatory Bowel Disease

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Patel, D., Trivedi, C. & Khan, N. Management of Anemia in Patients with Inflammatory Bowel Disease (IBD). Curr Treat Options Gastro 16, 112–128 (2018). https://doi.org/10.1007/s11938-018-0174-2

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