Inflammatory Bowel Disease
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 [5]. The highest incidence rates are observed in Europe and North America [4]
What is Inflammatory Bowel Disease (IBD)?
Inflammatory Bowel Disease (IBD) describes a set of chronic gastrointestinal illnesses, including Crohn’s disease (CD) and ulcerative colitis (UC) [5].
One third of patients with IBD have hemoglobin levels below 12 g/dL [6]
Do I have iron deficiency due to IBD?
Iron deficiency in IBD is caused by inadequate intake, malabsorption (including duodenal involvement and surgical removal) and chronic blood loss by mucosal ulcerations [1].
What are the symptoms related to IBD?
Signs and symptoms of iron deficiency depend on the severity and chronicity of the anemia, in addition to the usual signs of anemia, including fatigue, pallor, and reduced exercise capacity[1].
Key symptoms of anemia such as dyspnea and tachycardia, are caused by decreased blood oxygen levels and peripheral hypoxia [1]. Central hypoxia may lead to symptoms such as headache, dizziness, vertigo, or tinnitus [1].
IBD is associated with Iron Deficiency Anemia?
Anemia which is considered the most common metabolic complication of inflammatory bowel disease [1].
However, it is noteworthy that since IBD patients present with concomitant chronic intestinal bleeding, inflammatory and ulcerations, impaired absorption, malnutrition, the toxic effects of medications, and undergo surgical procedures, the exact etiology of anemia cannot be determined [1].
The prevalence of iron deficiency in IBD-associated anemia is estimated at around 36-90% [2,3].
The World Health Organization (WHO) definitions of anemia also apply to patients with IBD [7].
| Patient Group | Hemoglobin Level (Anemia) | Hematocrit Level (Anemia) | Hemoglobin Level (Severe IDA) |
|---|---|---|---|
| Males | < 13 g/dL | < 39% | < 10 g/dL |
| Nonpregnant Female | < 12 g/dL | < 36% | < 10 g/dL |
| Pregnant Females | < 11 g/dL | < 33% | < 10 g/dL |
Treatments
The treatment of IDA should not be overlooked. Iron supplementation should be started as soon as a patient is found to have iron deficiency anemia [6].
Important
IDA is the most common anemia in IBD, therefore, anemic patients with IBD should be evaluated for IDA. IDA mandates adequate and appropriate treatment, as it influences the patient’s quality of life and morbidity [1].
- Mahadea D, Adamczewska E, Ratajczak AE, Rychter AM, Zawada A, Eder P, Dobrowolska A, Krela-Kaźmierczak I. Iron Deficiency Anemia in Inflammatory Bowel Diseases-A Narrative Review. Nutrients. 2021 Nov 10;13(11):4008. doi: 10.3390/nu13114008. PMID: 34836263; PMCID: PMC8624004. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624004/
- Aksan A, Schoepfer A, Juillerat P, Vavricka S, Bettencourt M, Ramirez de Arellano A, Gavata S, Morin N, Valentine WJ, Hunt B. Iron Formulations for the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease: A Cost-Effectiveness Analysis in Switzerland. Adv Ther. 2021 Jan;38(1):660-677. doi: 10.1007/s12325-020-01553-1. Epub 2020 Nov 20. PMID: 33216324; PMCID: PMC7854431. - https://pubmed.ncbi.nlm.nih.gov/33216324/
- Eriksson C, Henriksson I, Brus O, Zhulina Y, Nyhlin N, Tysk C, Montgomery S, Halfvarson J. Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population-based cohort study. Aliment Pharmacol Ther. 2018 Sep;48(6):638-645. doi: 10.1111/apt.14920. Epub 2018 Aug 1. PMID: 30069892; PMCID: PMC6120551. - https://pubmed.ncbi.nlm.nih.gov/30069892/
- Mak WY, Zhao M, Ng SC, Burisch J. The epidemiology of inflammatory bowel disease: East meets west. J Gastroenterol Hepatol. 2020 Mar;35(3):380-389. doi: 10.1111/jgh.14872. Epub 2019 Nov 24. PMID: 31596960. - https://pubmed.ncbi.nlm.nih.gov/31596960/
- Kaitha S, Bashir M, Ali T. Iron deficiency anemia in inflammatory bowel disease. World J Gastrointest Pathophysiol. 2015 Aug 15;6(3):62-72. doi: 10.4291/wjgp.v6.i3.62. PMID: 26301120; PMCID: PMC4540708. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540708/
- Oldenburg B, Koningsberger JC, Van Berge Henegouwen GP, Van Asbeck BS, Marx JJ. Iron and inflammatory bowel disease. Aliment Pharmacol Ther. 2001 Apr;15(4):429-38. doi: 10.1046/j.1365-2036.2001.00930.x. PMID: 11284771. - https://pubmed.ncbi.nlm.nih.gov/11284771/
- Archived: Iron deficiency anaemia: assessment, prevention and control. https://www.who.int/publications/m/item/iron-children-6to23--archived-iron-deficiency-anaemia-assessment-prevention-and-control
Could you be experiencing iron deficiency?
