Management of Iron Deficiency and Anemia in Patients with Inflammatory Bowel Disease (IBD)

General Description

This pathway should be used to guide the management of patients with inflammatory bowel disease (IBD) with iron deficiency with or without anemia.

Inclusion Criteria

Patients diagnosed with inflammatory bowel disease

Exclusion Criteria

None

Background

Anemia is an important and very common complication of IBD. Studies report an even greater prevalence among children (~70%) than adults (~40%) at any given time during disease course. In the majority of cases, anemia is a result of chronic iron deficiency (ID) and chronic inflammation (anemia of chronic inflammation or previously called anemia of chronic disease) or a combination of both.

Anemia of chronic inflammation (ACI) results from suppression of erythropoiesis driven by inflammatory cytokines and iron sequestration from increase hepcidin (referred as functional ID). Notably, hepcidin also reduces iron duodenal absorption and may therefore leads to absolute ID.

Both anemia and ID itself have been associated with high rates of IBD-related complications, resource utilization, and impaired quality of life. Prevention of anemia and maintenance of iron stores are therefore important.

To align clinical practice with guideline recommendations, this clinical care pathway provides guidance for screening, treatment, and follow-up of ID and anemia among patients with IBD. In the absence of specific pediatric guidance, these recommendations are based on international adult clinical guidelines and evidence-based pediatric publications. This clinical pathway does not address indications for blood transfusion.