Management of Anemia in Patients with Inflammatory Bowel Disease

Kyeong Ok Kim

doi:10.4166/kjg.2015.65.3.145

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Kim: Management of Anemia in Patients with Inflammatory Bowel Disease

Review Article

Korean J Gastroenterol 2015;65(3):145-150.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.3.145

Management of Anemia in Patients with Inflammatory Bowel Disease

Kyeong Ok Kim

Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

Correspondence to: Kyeong Ok Kim, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea. Tel: +82-53-620-3835, Fax: +82-53-623-8038, E-mail: kokim@yu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Anemia is one of the commonest extraintestinal manifestations of inflammatory bowel disease (IBD). The pathogenesis of anemia in IBD is complex but iron deficiency combined with inflammation is the most common factor related to the development of anemia. However, other causes such as vitamin B12 and folate deficiency, hemolysis, myelosuppression and drug also should not be overlooked. In addition to ferritin, inflammatory markers and new biochemical parameters such as hepcidin and ferritin index are being tested as diagnostic a tool. First step for treatment is disease activity control and iron supplementation. Although oral iron is widely used, intravenous iron therapy should be considered in patients who are intolerant to oral iron therapy, have severe and refractory anemia or are in active disease state. Recently, new intravenous iron formulations have been introduced and due to their safety and easy usage, they have become the standard treatment modality for managing anemia in IBD. Erythropoietin and transfusion can be considered in specific situations. Vitamin B12 and folate supplementation is also important in patients who are deficient of these micronutrients. Since anemia in IBD patients could significantly influence the disease outcome, further studies and standard guideline for IBD are needed.

Keywords: Anemia, Inflammatory bowel diseases, Iron deficiency, Inflammation

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Table 1.

Useful Markers for Differentiation of Anemia in Inflammatory Bowel Disease

Parameter	IDA	ACD	IDA+ACD
MCV (fL)	<80	Reduced or normal	Reduced or normal
CRP	Normal	Increased	Increased
Ferritin (ng/mL)	<30	>100	30-100
Transferrin	Increased	Reduced or normal	Reduced
Tsat (%)	<16	<16	<16
Ferritin index	>3.2	<1	>2
Hepcidin (nmol/L)	Reduced	>4	>4
CHr (pg)	<28	>28	<28

IDA, iron deficiency anemia; ACD, anemia of chronic eisease; MCV, mean corpuscular volume; Tsat, transferrin saturation; CHr, reticulocyte hemoglobin content.

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