Anemia of Chronic Disease and Iron Deficiency Anemia in Inflammatory Bowel Diseases

Abstract

Anemia coexists with inflammatory bowel disease (IBD) in up to two-thirds of patients, significantly impairing quality of life. The most common types of anemia in patients with IBD are iron deficiency anemia and anemia of chronic disease, which often overlap. In most cases, available laboratory tests allow successful diagnosis of iron deficiency, where difficulties appear, recently established indices such as soluble transferrin-ferritin ratio or percentage of hypochromic red cells are used. In this review, we discuss the management of the most common types of anemia in respect of the latest available data. Thus, we provide the mechanisms underlying pathophysiology of these entities; furthermore, we discuss the role of hepcidin in developing anemia in IBD. Next, we present the treatment options for each type of anemia and highlight the importance of individual choice of action. We also focus on newly developed intravenous iron preparations and novel, promising drug candidates targeting hepcidin. Concurrently, we talk about difficulties in differentiating between the true and functional iron deficiency, and discuss tools facilitating the process. Finally, we emphasize the importance of proper diagnosis and treatment of anemia in IBD. We conclude that management of anemia in patients with IBD is tricky, and appropriate screening of patients regarding anemia is substantial.

Micronutrient Deficiencies in Children With Inflammatory Bowel Diseases

“…This extremely high prevalence of iron deficiency at diagnosis is attributed to many known factors, such as decreased intake, gastrointestinal bleeding and iron loss, decreased absorption capacity, as well as chronic inflammation. 24 Indeed, in our study, iron deficiency correlated with markers of severe or more extensive disease such as high CRP and low serum albumin level, L3, and L4 phenotypes; all of these are markers of higher inflammatory burden. Disease activity in the proximal jejunum (as part of L4 phenotype) may also contribute to iron deficiency directly through decreased iron absorption.…”

“…According to other studies, up to 90% of patients with IBD will have iron deficiency at presentation. This extremely high prevalence of iron deficiency at diagnosis is attributed to many known factors, such as decreased intake, gastrointestinal bleeding and iron loss, decreased absorption capacity, as well as chronic inflammation . Indeed, in our study, iron deficiency correlated with markers of severe or more extensive disease such as high CRP and low serum albumin level, L3, and L4 phenotypes; all of these are markers of higher inflammatory burden.…”

Iron Deficiency Anemia

“…16,[19][20][21] Patients who have inflammatory bowel disease have a high incidence of iron deficiency. 22 Iron insufficiencies are due to the presence of inflamed bowel losing blood, as well as the marked inflammatory state leading to a rise in hepcidin levels blocking iron absorption. In those patients who require bowel surgery, this also adds to the stress on iron stores.…”

Diagnosis and treatment of anemia in patients with inflammatory bowel disease

“…It is well known that a significant number of IBD patients develop ID. A combination of chronic intestinal blood loss, dietary restrictions and/or iron malabsorption caused by mucosal inflammation or surgical bowel resections (especially in CD patients) leads to a disequilibrium of iron demand and absorption [4,11,22]. …”