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Diagnosis and management of iron deficiency anemia in patients with IBD

Nature Reviews Gastroenterology & Hepatology volume 7, pages 599–610 (2010)Cite this article

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Abstract

Anemia is the most prevalent extraintestinal complication of IBD. It can affect quality of life and ability to work, and can also increase the hospitalization rate in patients with IBD. Although the causes of anemia in IBD are multifactorial, iron deficiency anemia (IDA) is the most common. Assessment of the iron status of patients who have a condition associated with inflammation, such as IBD, by using common biochemical values is insufficient. However, new indices of iron metabolism (for instance ferritin:transferrin receptor ratio, reticulocyte hemoglobin content or percentage of hypochromic red blood cells) may help to improve the assessment of iron status in patients with IBD. The treatment of IDA traditionally involves oral iron supplementation. However, because of extensive gastrointestinal adverse effects, and data showing that the use of oral iron in IBD may be associated with disease exacerbation, current guidelines suggest that iron supplementation in IBD should be administered intravenously. This Review provides an overview of iron homeostasis in health before discussing diagnostic and therapeutic strategies for IDA in patients with IBD.

Key Points

  • Anemia is the most prevalent extraintestinal complication of IBD

  • Although there are several causes of anemia in IBD, iron deficiency anemia (IDA) is the most common

  • Common biochemical values are insufficient for assessing the iron status of patients who have an inflammatory condition, such as IBD

  • The major goal of therapy for IDA is to supply sufficient iron to increase hemoglobin levels by >2 g/dl or increase them to normal values within 4 weeks, and to replenish iron stores

  • Iron supplementation should be administered intravenously to patients with IBD, even though many will respond to oral administration of iron

  • Compared with oral iron therapy, in patients with IBD intravenous iron replenishes iron stores more effectively and overcomes the block to intestinal iron absorption induced by hepcidin

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Figure 1: Iron homeostasis in the healthy state.
Figure 2: Mechanisms of duodenal absorption of heme and nonheme iron.
Figure 3: Role of hepcidin in the regulation of intestinal iron absorption.
Figure 4: Algorithm for the management of iron deficiency anemia in IBD.

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Authors and Affiliations

  1. Gastroenterology and Clinical Nutrition, St Elisabeth Hospital, Katharina Kasper Clinics, Teaching Hospital of the Goethe University Frankfurt, Ginnheimer Street 3, Frankfurt, D-60487, Germany

    Jürgen Stein

  2. Department of Medicine, St Marien Hospital, Katharina Kasper Clinics, Teaching Hospital of the Goethe University Frankfurt, Richard Wagner Street 14, Frankfurt, D-60318, Germany

    Franz Hartmann

  3. Department of Medicine, Markus Krankenhaus, Frankfurter Diakonie Clinics, Teaching Hospital of the Goethe University Frankfurt, Wilhelm Epstein Street 2, Frankfurt/Main, D-60431, Germany

    Axel U. Dignass

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J. Stein contributed to the research, discussion, writing and reviewing of the manuscript. F. Hartmann and A. Dignass contributed to the research, discussion and reviewing of the manuscript.

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Stein, J., Hartmann, F. & Dignass, A. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol 7, 599–610 (2010). https://doi.org/10.1038/nrgastro.2010.151

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