Pathway for Evaluation and Treatment of Iron Deficiency and
Anemia in Patients with Inflammatory Bowel Disease (IBD)
  • ID: Iron deficiency
  • IDA: Iron deficiency anemia
  • Hb: Hemoglobin
  • TSAT: Transferrin saturation
CHOP Hemoglobin Normal Values
Age (years) Hb (g/dL)
  Male Female
6 mo - 2 10.5 - 13.5
2-6 11.5 - 13.5
6-12 11.5 - 15.5
12-18 13.0 - 16.0 12.0 - 16.0
> 18 13.5 - 17.5 12.0 - 16.0
Iron deficiency in relation to disease activity
Inactive IBD Ferritin < 30 ug/L
Active IBD Ferritin < 100 ug/L and TSAT < 20%
Universal screening for iron deficiency and anemia
  • Order: CBC
    • Ferritin
    • TSAT
    • Reticulocyte count
Assess for anemia (refer to CHOP Hb normal values)
Assess for iron deficiency in relation to disease activity
No anemia
and
adequate iron store
Anemia
with
adequate iron store
Iron deficiency
without
anemia
Iron deficiency
with
anemia
Universal screening
Inactive IBD Every 6 months
Active IBD Every 3 months
  • Determine route of iron therapy based on:
    • Disease activity
    • Anemia severity
Active IBD
Inactive IBD
Assess severity of anemia
(Refer to WHO anemia severity range)
Moderate or severe IDA
Mild or non-anemic ID
Assess response in anemic patients
Repeat CBC and reticulocyte count in 4 weeks
Achievement of therapeutic goals of iron therapy
Normalization of Hb by 4-8 weeks
And
Normalization of iron store
Prevention of recurrent iron deficiency and anemia
Repeat CBC, ferritin, TSAT, reticulocyte count, every 3 months
for at least a year after correction
WHO anemia severity range (g/dL)
Mild Moderate Severe
< 5 < 11 < 10 < 7
≥ 5 < 11.5 < 11 < 8
12 - 14 < 12 < 11 < 8
≥ 15 (F) < 12 (M) < 13 < 11 < 8
Posted: November 2018
Authors: Breton, J. MD; Grossman, A. B. MD; Witmer, C. MD; Stevenson J. RN; McDermott J. RN; Schwab E. RD;
Law, C. PharmD; Downing M. MHA