Anemia in inflammatory bowel disease: prevalence, differential diagnosis and association with clinical and laboratory variables

Abstract

CONTEXT AND OBJECTIVES: Anemia is the most frequent extraintestinal complication of inflammatory bowel disease. This study aimed to: 1) determine the prevalence of anemia among patients with inflammatory bowel disease; 2) investigate whether routine laboratory markers are useful for diagnosing anemia; and 3) evaluate whether any association exists between anemia and clinical/laboratory variables. DESIGN AND SETTING: Cross-sectional at a federal university. METHODS: 44 outpatients with Crohn's disease and 55 with ulcerative colitis were evaluated. Clinical variables (disease activity index, location of disease and pharmacological treatment) and laboratory variables (blood count, iron laboratory, vitamin B 12 and folic acid) were investigated. RESULTS: Anemia and/or iron laboratory disorders were present in 75% of the patients with Crohn's disease and in 78.2% with ulcerative colitis. Anemia was observed in 20.5% of the patients with Crohn's disease and in 23.6% with ulcerative colitis. Iron-deficiency anemia was highly prevalent in patients with Crohn's disease (69.6%) and ulcerative colitis (76.7%). Anemia of chronic disease in combination with iron deficiency anemia was present in 3% of the patients with Crohn's disease and in 7% of the patients with ulcerative colitis. There was no association between anemia and disease location. In ulcerative colitis, anemia was associated with the disease activity index. CONCLUSIONS: Most patients present iron laboratory disorders, with or without anemia, mainly due to iron deficiency. The differential diagnosis between the two most prevalent types of anemia was made based on clinical data and routine laboratory tests. In ulcerative colitis, anemia was associated with the disease activity index. RESUMO CONTEXTO E OBJETIVOS:Anemia é a mais frequente complicação extraintestinal na doença inflamatória intestinal. Este estudo objetivou: 1) determinar a prevalência de anemia em portadores de doença inflamatória intestinal; 2) investigar se os marcadores laboratoriais de uso rotineiro são úteis para o diagnóstico da anemia; 3) avaliar se existe associação entre anemia e variáveis clínico-laboratoriais. TIPO DE ESTUDO E LOCAL: Estudo transversal em uma universidade federal. MÉTODOS: Foram avaliados 44 pacientes ambulatoriais com doença de Crohn e 55 com retocolite ulcerativa. Foram investigados aspectos clínicos (índice de atividade da doença, localização da doença e tratamento farmacológico) e laboratoriais (hemograma, ferrocinética, vitamina B 12 e ácido fólico). RESULTADOS: Anemia e/ou anormalidades na ferrocinética estavam presentes em 75% dos pacientes com doença de Crohn e em 78,2% dos pacientes com retocolite. Anemia foi observada em 20,5% do grupo com doença de Crohn e em 23,6% do grupo com retocolite. Anemia por deficiência de ferro predominou entre os pacientes com doença de Crohn (69,6%) e com retocolite (76,7%). Anemia de doença crô-nica associada à anemia ferropriva estava presente em 3% dos pacientes com doença de Crohn e em 7% daqueles com retocolite. Na reto...

Anemia in Inflammatory Bowel Disease Outpatients: Prevalence, Risk Factors, and Etiology

“…This finding is in accordance with an overall prevalence of anemia (24%, 95% CI, 18–31) found on a recent meta-analysis evaluating 2192 IBD patients in European countries [ 18 ]. Other studies reported similar prevalence between 17% and 20% [ 19 – 21 ] which differs from the higher prevalence of anemia found in the studies of Bergamisch et al [ 13 ] (65%) and Høivik et al [ 4 ] (48.8% on CD and 20.2% on UC). This probably is due to the fact that our study was conducted in patients who were already under IBD treatment while the latter two studies evaluated patients before starting treatment.…”

Nutrition and IBD: Malnutrition and/or Sarcopenia? A Practical Guide

“…Iron deficiency is the most frequent cause of anemia in IBD patients, like in healthy people, with prevalence estimated in 36–90% [17]. It was demonstrated that iron deficiency has multifactorial etiology, including inadequate intake, blood loss from damaged intestinal wall, impairment absorption (disease localization in duodenum or proximal tract of jejunum), and impairment utilization (due to the systemic inflammatory status) [18, 19]. Furthermore, iron absorption and metabolism are regulated by Hepcidin and soluble transferrin receptors, the first being an important hormone depressing iron absorption and iron release from body stores in iron-overload and in inflammatory status; the second, conversely, increases during iron deficiency status and increases intestinal absorption and release from stores.…”

Anemia in Inflammatory Bowel Disease: An Under-Estimated Problem?

“…Better parameters to identify iron deficiency such as soluble transferrin receptor (sTfR) are not applied widely ( 26 ). If the “traditional” markers appeared to be in a normal range and there still was an anemic blood count in IBD patients, this was attributed to “anemia of chronic disease” ( 24 , 27 – 29 ). Consecutively, this was a diagnosis of exclusion and no positive criteria were used.…”