Iron deficiency anemia in inflammatory bowel disease

Abstract

Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia (IDA) secondary to chronic blood loss, and impaired iron absorption due to tissue inflammation. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with IBD must be regularly monitored for earlier detection of anemia. IDA in IBD is associated with poor quality of life, necessitating prompt diagnosis and appropriate treatment. IDA is often associated with inflammation in patients with IBD. Thus, commonly used laboratory parameters are inadequate to diagnose IDA, and newer iron indices, such as reticulocyte hemoglobin content or percentage of hypochromic red cells or zinc protoporphyrin, are required to differentiate IDA from anemia of chronic disease. Oral iron preparations are available and are used in patients with mild disease activity. These preparations are inexpensive and convenient, but can produce gastrointestinal side effects, such as abdominal pain and diarrhea, that limit their use and patient compliance. These preparations are partly absorbed due to inflammation. Non-absorbed iron can be toxic and worsen IBD disease activity. Although cost-effective intravenous iron formulations are widely available and have improved safety profiles, physicians are reluctant to use them. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.

Differential diagnosis of anemia in pregnant women

“…В отечественных и зарубеж-ных научных изданиях представлены публикации, посвященные изучению изменения концентрации гепсидина в сыворотке крови при анемических состояниях [37,65], в том числе у пациентов с со-путствующими заболеваниями различной ýтиоло-гии: ревматоидным артритом [66][67][68][69], воспалени-ем кишечника [70,71], нейропатологией [72,73], онкопатологией [74][75][76][77] и др. Результаты прове-денных исследований в большинстве своем ука-зывают на целесообразность включения гепсиди-на в алгоритмы дифференциальной диагностики различных видов анемического синдрома.…”

Anemia in Inflammatory Bowel Diseases in Children

“…Гепсидин Гепсидин рассматривают в качестве одного из основ-ных регуляторов метаболизма железа, который играет ключевую роль в развитии анемии хронических забо-леваний [49,50]. Концентрацию этого синтезируемого в печени мелкого пептида, состоящего из 25 аминокис-лот, можно определять как в сыворотке крови, так и в моче [51,52].…”

Diagnosis and treatment of iron deficiency anemia in patients with inflammatory bowel disease and gastrointestinal bleeding: iron deficiency anemia working group consensus report

“…The symptoms of anemia include fatigue, headache, dizziness, tachycardia, dyspnea, loss of libido, nausea, vertigo, tinnitus, weight loss, motility disorder, lethargy, and syncope, although patients may also remain asymptomatic or minimally symptomatic (13). ID without anemia may also result in the same symptoms or may be asymptomatic.…”

“…There are two main reasons of IDA in IBD. First, increased iron loss due to acute/ chronic blood loss and second, decreased iron absorption due to inadequate diet, inflammation, or surgery (13)(14)(15)(16).…”

“…There are two treatment approaches available for the management of IDA in IBD: i) Oral iron administration if the patient has mild-to-moderate anemia (Hb>10 g/dL), if the disease is inactive (C-reactive protein (CRP)<5 mg/L), and if there is good tolerance, adherence, and sufficient response (Hb>2 g/dL in 4 weeks); ii) Direct initiation of IV iron therapy regardless of Hb and CRP levels (3,(13)(14)(15)(20)(21)(22)(23)(24).…”