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Screening, Prevalence and Inappropriate Iron Supplementation in Anemia in Patients at an Urban Tertiary Referral IBD Center
Journal article   Peer reviewed

Screening, Prevalence and Inappropriate Iron Supplementation in Anemia in Patients at an Urban Tertiary Referral IBD Center

Neilanjan Nandi, Meet Parikh, Khine Shan and Dhruvan Patel
The American journal of gastroenterology, v 113(Supplement), pp S1559-S1559
01 Oct 2018
DOI: https://doi.org/10.14309/00000434-201810001-02811

Abstract

Anemia Endoscopy Iron
Introduction: Anemia is a common extra-intestinal manifestation of IBD, frequently resulting from iron deficiency. European literature suggests IDA is commonly undertreated in IBD patients whereas data in the United States is limited. We investigated the diagnosis, treatment, and iron supplementation of anemic IBD patients. Methods: From 2008-2018, patients presenting to an inner-city tertiary referral IBD center were reviewed including inpatient and outpatient charts to assess clinical data, labs, endoscopy reports, imaging, operative reports, and medication use. Anemia and its severity was defined per WHO criteria: Mild anemia (Hb 11-12.9 g/dL in male and 11-11.9 g/dL in female), moderate anemia (Hb 8-10.9 g/dL in both genders) and severe anemia (Hb <8 g/dL in both genders). Iron deficiency was defined as: ferritin <30 pg/L and/or transferrin saturation <16%. In patients with a ferritin between 30 and 100 pg/L at the time of evaluation, corresponding ESR/CRP levels and endoscopy reports were evaluated to determine disease activity. If they had active disease and ferritin less than a hundred, they were considered iron deficient. Results: 265 patients were analyzed with a median age of 36 years. The majority of patients were female (58%) and Caucasian (66%). Phenotypically, 37% had UC, 58.6% had CD and 4.3% had indeterminate colitis. 138 patients (52%) were found to be anemic during the follow up duration. There was no significant difference of anemia prevalence between UC and CD (48% vs 54 %, p 0.34). Of 138 patients with anemia, 63 (46%) had mild anemia, 55 (40%) had moderate anemia, and 20 (14%) had severe anemia. Iron panel in 120 patients (87%) revealed that 82 patients (68%) were diagnosed with IDA. Of the 82 patients with IDA, only 41 patients (50%) were treated with iron supplementation: 32 patients (39%) with oral iron and 19 patients (23%) with IV iron. Notably, iron supplementation was given in 40 out of 183 patients without IDA (22%). Among these 40 patients, 15 had anemia of chronic disease, 20 had no anemia, and 5 did not have an iron panel performed to characterize anemia. Conclusion: Half of the IBD patients in our study demonstrated anemia with two-thirds found to be iron deficient. Despite the high prevalence of IDA, only 50% patients were treated with iron supplementation. However, 22% patients without IDA were inappropriately given iron therapy. Greater proactive management of IDA is necessary but inappropriate iron supplementation should be prevented.

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