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Under Utilization of Iron Supplementation in Inflammatory Bowel Disease (IBD) Patients With Iron Deficiency Anemia (IDA): An Experience at a Tertiary Referral IBD Center
Journal article   Peer reviewed

Under Utilization of Iron Supplementation in Inflammatory Bowel Disease (IBD) Patients With Iron Deficiency Anemia (IDA): An Experience at a Tertiary Referral IBD Center

Meet Parikh, Khine Shan, Dhruvan Patel and Neilanjan Nandi
The American journal of gastroenterology, v 113(Supplement), pp S337-S339
01 Oct 2018
DOI: https://doi.org/10.14309/00000434-201810001-00589

Abstract

Anemia Endoscopy Inflammatory bowel disease Inner city Iron
Introduction: Anemia is a common extra-intestinal complication of inflammatory bowel disease (IBD) and frequently manifests as iron deficiency. European literature suggests iron deficiency anemia (IDA) is common in active IBD. We aim to investigate the utilization of iron supplementation in IBD patients with IDA and their impact on disease activity at an inner-city tertiary referral IBD center. Methods: IBD patients referred to an inner-city tertiary referral center from 2008-2018 underwent inpatient and outpatient chart review for clinical data, labs, endoscopy reports, imaging, operative reports, and medication use. Anemia and its severity was defined per WHO criteria. Iron deficiency was defined as a 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. Differences between the two groups were evaluated using the Mann-Whitney U test for non-parametric continuous data and chi-square test for categorical variables. Results: 265 patients were included in the analysis. 138 patients (52%) were found to be anemic during the follow up duration. Iron panel was performed in 120 patients (87%) and among them, 82 patients (68%) were diagnosed with IDA. Of 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. Table 1 compared IDA patients who were given iron supplements with IDA patients without iron supplements. Patients who were treated with iron supplementation were likely to have more severe anemia than patients without iron supplementation (27% vs 10%, p 0.006). There was no significant difference observed in disease activity or health care utilization between the two groups (Table 1). However, IDA patients treated with iron supplementation were less likely to have surgery for IBD compared to patients without iron supplementation (41% vs 63%, p 0.04). Conclusion: Only half of IDA patients were treated with iron supplementation. Patients receiving iron supplementation were more likely to have severe anemia and, notably, less likely to undergo surgery for IBD. This relationship is counterintuitive and emphasizes that physicians should be more educated in iron supplementation and that further research is required.

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