Current approach to anaemia in patients with inflammatory bowel disease

Abstract

Inflammatory bowel diseases (IBD) - Crohn's disease and ulcerative colitis - are commonly associated with a number of extraintestinal complications, including anaemia. Anaemia is considered to be a key symptom and is a common clinical feature of IBD in one-third of patients. Although anaemia in IBD is multifactorial, iron deficiency and anaemia of chronic disease are the most important causes of anaemia in this population. Iron deficiency develops due to several factors, including blood loss from intestinal bleeding, food aversions affecting the amount of dietary iron available and malabsorption of iron in Crohn's disease patients. Anaemia of chronic disease is also caused by inflammation that further blocks iron absorption capacity. Anaemia has an important negative impact on the quality of life. Chronic blood loss results in the depletion of iron stores before anaemia manifests itself, and it is therefore of utmost importance that physicians screen their IBD patients for iron deficiency (at least annually even in patients in clinical remission) and manage it appropriately. Oral iron is traditionally the first-line treatment for reasons of convenience and cost, although it has suboptimal tolerability, particularly in IBD patients, who develop diarrhoea and increased abdominal pain and worsening of the course of IBD. Intravenous iron is highly efficacious, better tolerated and can be safely combined with other i.v. treatments such as biologicals. Erythropoietin is effective for the treatment of the anaemia of chronic disease and should be considered in IBD patients if Hb is less than lOg/dL or if there is no response to i.v. iron therapy within 4 weeks. Only as a very last resort should blood transfusions be considered to replenish iron.