Inflammatory Bowel Disease with Iron Deficiency and Anemia Clinical Pathway – All Settings

Clinical Pathway for Evaluation and Treatment of Iron Deficiency
and Anemia in Patients with Inflammatory Bowel Disease (IBD)

Goals and Metrics
Patient Education
Child with Inflammatory Bowel Disease (IBD) and Concern for Iron Deficiency with or without Anemia
 
 

Universal Screening for Iron Deficiency and Anemia

  • CBC, reticulocyte count
  • Iron panel
    • Serum iron, TIBC, transferrin, transferrin saturation (TSAT)
  • Ferritin
  • Soluble transferrin receptor (STFR)
  • Active IBD q3mos
  • Inactive IBD q6mos
Iron Deficiency in Relation to Disease Activity
Active IBD
  • Ferritin < 100 µg/L and TSAT < 20%
  • Elevated soluble transferrin receptor
Inactive IBD
  • Ferritin < 30 µg/L
  • Elevated soluble transferrin receptor
 
 
Interpretation of Iron Studies
 
 
 
 
 
 
Adequate iron stores,
No anemia
Adequate iron stores,
Anemia
Iron deficiency
with or without anemia
 
 
 
 
 
 
 
 
Inactive IBD
Active IBD

Continue universal screening

Inactive IBD: q6mos
Active IBD: q3mos

Evaluate for other causes of anemia
Assess anemia level
WHO Anemia Severity Range Hgb (g/dL)
Age (yrs) Mild Moderate Severe
< 5 < 11 < 10 < 7
≥ 5 < 11.5 < 11 < 8
12–14 < 12 < 11 < 8
≥ 15 (F) < 12 (M) < 13 < 11 < 8
 
 
 
 
Mild or
non-anemic
Moderate or severe

IV Iron Rationale

Enteral Iron
IV Iron
 
 
 
 
Review hematologic response to iron
Repeat CBC and reticulocyte in 4 wks
 
 
 
 
Normalization or hgb increase by ≥ 2g/dL from baseline and normalization of iron store
Inadequate hgb or iron store response to iron treatment
  • Prevent Recurrent Iron Deficiency and Anemia
    • Anemia recurs in > 50% of children with IBD within 10–12 mos
    • Recommend q3mo universal screening for 1 yr after correction at minimum
    • Rapid recurrent iron deficiency with or without anemia may be indicative of subclinical disease activity
  • Administer IV Iron if failed or concern for poor adherence to oral regimen
  • Reassess disease activity, blood loss, other causes of anemia
  • Consider hematology referral