Portuguese Consensus on Diagnosis, Treatment, and Management of Anemia in Pediatric Inflammatory Bowel Disease

Lopes, Ana Paula; Azevedo, Sara; Cabral, José; Ferreira, Maria Gomes; Sande-Lemos, Piedade; Ferreira, Rosa Cristina Moutinho; Trindade, Eunice; Lima, Rosa; Antunes, Henedina

doi:10.1159/000505071

Cited by 5 publications

(5 citation statements)

References 66 publications

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“…Following the concept of multifactorial development of thrombosis ( 52 ), ID or IDA add to established risk factors as inflammation, steroid therapy, protein loss or dehydration ( 53 , 54 ) further increasing thrombosis risk in children with IBD. These data support trials investigating the impact iron replacement in children with IBD has on the incidence of thromboembolic events ( 4 , 55 ).…”

Section: High-risk Patient Groupssupporting

confidence: 79%

Iron deficiency anemia and thrombosis risk in children—revisiting an old hypothesis

2022

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Iron deficiency anemia has a high prevalence in children and has repeatedly been implicated as a risk factor for arterial and venous thrombosis. As an effective therapy for iron deficiency anemia is available, understanding the association between this form of anemia and the potentially severe thrombosis phenotype is of major clinical interest. Recent findings shed light on pathophysiology of hypercoagulability resulting from iron-restricted erythropoiesis. Specifically, an animal model of induced iron deficiency allowed identifying multiple mechanisms, by which iron deficiency anemia results in increased thrombus formation and thrombus progression both in arterial and venous thrombosis. These findings complement and support conclusions derived from clinical data. The purpose of this mini review is to summarize current evidence on the association of iron deficiency anemia and thrombosis. We want to increase the awareness of iron deficiency as a risk factor for thrombosis in the pediatric population. We discuss how novel pathophysiological concepts can be translated into the clinical settings and suggest clinical studies on prevention and treatment strategies in high-risk patient groups.

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Section: High-risk Patient Groupssupporting

confidence: 79%

Iron deficiency anemia and thrombosis risk in children—revisiting an old hypothesis

2022

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“…Oral iron therapy is the standard, easily administered, and cheap treatment for the management of pediatric IBD-associated IDA. 2 – 4 However, it has several limitations including gastrointestinal side effects, poor compliance, and impaired iron absorption due to inflammation. 17 In addition, animal studies proposed that oral elemental iron may catalyze reactions that generate oxygen-free radicals that can exacerbate inflammation and worsen the symptoms of IBD.…”

Section: Discussionmentioning

confidence: 99%

“… 1 The pathophysiology of anemia in IBD is multifactorial and it involves a combination of both iron-deficiency anemia (IDA) and anemia of chronic disease (ACD). 2 …”

Section: Introductionmentioning

confidence: 99%

“… 3 ACD is also involved in alterations in iron absorption, distribution, and transport in addition to decreased erythropoiesis. 2 – 4 IDA in children is commonly treated with oral and intravenous iron therapy; however, oral iron supplements are commonly associated with poor compliance due to gastrointestinal side effects such as abdominal pain, nausea, and vomiting. 5 …”

Section: Introductionmentioning

confidence: 99%

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Lactoferrin for iron-deficiency anemia in children with inflammatory bowel disease: a clinical trial

et al. 2022

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Background Iron-deficiency anemia (IDA) is common in children with inflammatory bowel disease (IBD); however, oral iron supplements are commonly associated with poor compliance due to gastrointestinal side effects. We compared the effect of lactoferrin versus oral ferrous sulfate for the treatment of IDA in children with IBD. Methods Ninety-two IBD children with IDA were included but only 80 children completed the study and they were randomized into two groups: ferrous sulfate group (n = 40) who received ferrous sulfate 6 mg/kg/day for 3 months and lactoferrin group (n = 40) who received lactoferrin 100 mg/day for 3 months. Complete blood count, serum iron, total iron-binding capacity (TIBC), transferrin saturation (TS), serum ferritin, interleukin-6 (IL-6), and hepcidin 25 were measured before and after the treatment. Results Hemoglobin (Hb), mean corpuscular volume, serum iron, TS, and serum ferritin significantly increased, while TIBC decreased significantly after the administration of either ferrous sulfate or lactoferrin compared to their baseline data. In addition, lactoferrin significantly increased Hb, serum iron, TS, and serum ferritin compared to ferrous sulfate. Moreover, lactoferrin significantly decreased IL-6 and hepcidin levels. Conclusion Lactoferrin is a promising effective treatment with fewer side effects than oral elemental iron in children with IBD and IDA. Clinical trial registration The study was registered at www.pactr.org (PACTR202002763901803). Impact Iron-deficiency anemia (IDA) in children with inflammatory bowel disease (IBD) is treated with oral iron therapy; however, oral iron supplements are commonly associated with poor compliance due to gastrointestinal side effects. To the best of our knowledge, our study was the first in pediatrics that compared the effect of lactoferrin versus oral ferrous sulfate as an iron supplement for the treatment of IDA in children with IBD. We found that lactoferrin is a promising effective treatment with fewer side effects than oral elemental iron in children with IBD and IDA.

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“…Nevertheless, there is mixed enthusiasm about the use of IV iron in children[ 16 ]. This reluctance likely arises from concerns about adverse reactions associated with IV iron administration and the lack of published data on the clinical efficacy and safety of newer IV iron formulations in this patient population[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience

Manokaran,

Spaan,

Cataldo

et al. 2024

World J Clin Pediatr

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BACKGROUND Screening for iron deficiency anemia (IDA) is important in managing pediatric patients with inflammatory bowel disease (IBD). Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous (IV) iron to treat IDA in this population. AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center. METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019. 92 patients met study criteria for IDA, of which 57 received IV iron, 17 received oral iron, and 18 were discharged prior to receiving iron therapy. RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9 (± 0.2) g/dL in mean (± SE) hemoglobin (Hb) concentration by the first ambulatory follow-up, compared to patients who received oral iron 0.8 (± 0.3) g/dL or no iron 0.8 (± 0.3) g/dL (P = 0.03). One out of 57 (1.8%) patients that received IV iron therapy experienced an adverse reaction. CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.

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Portuguese Consensus on Diagnosis, Treatment, and Management of Anemia in Pediatric Inflammatory Bowel Disease

Cited by 5 publications

References 66 publications

Iron deficiency anemia and thrombosis risk in children—revisiting an old hypothesis

Iron deficiency anemia and thrombosis risk in children—revisiting an old hypothesis

Lactoferrin for iron-deficiency anemia in children with inflammatory bowel disease: a clinical trial

Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience

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