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. 2022 Nov 19;11(22):6843.
doi: 10.3390/jcm11226843.

Anemia and Iron Deficiency in Outpatients with Inflammatory Bowel Disease: Ubiquitous Yet Suboptimally Managed

Roberta Loveikyte  1   2 , Menno Boer  1 , Catharina N van der Meulen  1 , Rinze W F Ter Steege  3 , Greetje Tack  4 , Johan Kuyvenhoven  5 , Bindia Jharap  6 , My K Vu  7 , Lauran Vogelaar  8 , Rachel L West  9 , Sander van der Marel  10 , Tessa E H Römkens  11 , Zlatan Mujagic  12 , Frank Hoentjen  13   14 , Adriaan A van Bodegraven  15 , Fiona D M van Schaik  16 , Annemarie C de Vries  17 , Gerard Dijkstra  2 , Andrea E van der Meulen-de Jong  1 ; Dutch Initiative on Crohn and Colitis (ICC)
Affiliations

Anemia and Iron Deficiency in Outpatients with Inflammatory Bowel Disease: Ubiquitous Yet Suboptimally Managed

Roberta Loveikyte et al. J Clin Med. .

Abstract

Background: Iron deficiency (ID) and anemia in patients with Inflammatory Bowel Disease (IBD) are associated with a reduced quality of life. We assessed the prevalence of ID and anemia in Dutch outpatients with IBD and compared routine ID(A) management among medical professionals to the European Crohn’s and Colitis Organisation (ECCO) treatment guidelines. Methods: Between January and November 2021, consecutive adult outpatients with IBD were included in this study across 16 Dutch hospitals. Clinical and biochemical data were extracted from medical records. Additionally, medical professionals filled out questionnaires regarding routine ID(A) management. Results: In total, 2197 patients (1271 Crohn’s Disease, 849 Ulcerative Colitis, and 77 IBD-unclassified) were included. Iron parameters were available in 59.3% of cases. The overall prevalence of anemia, ID, and IDA was: 18.0%, 43.4%, and 12.2%, respectively. The prevalence of all three conditions did not differ between IBD subtypes. ID(A) was observed more frequently in patients with biochemically active IBD than in quiescent IBD (ID: 70.8% versus 23.9%; p < 0.001). Contrary to the guidelines, most respondents prescribed standard doses of intravenous or oral iron regardless of biochemical parameters or inflammation. Lastly, 25% of respondents reported not treating non-anemic ID. Conclusions: One in five patients with IBD suffers from anemia that—despite inconsistently measured iron parameters—is primarily caused by ID. Most medical professionals treat IDA with oral iron or standard doses of intravenous iron regardless of biochemical inflammation; however, non-anemic ID is often overlooked. Raising awareness about the management of ID(A) is needed to optimize and personalize routine care.

Keywords: Inflammatory Bowel Disease; anemia; iron deficiency.

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Conflict of interest statement

G.D. received research grants from Royal DSM and speaker’s fees from Janssen Pharmaceuticals, Takeda, Pfizer, and Abbvie. A.E.v.d.M.-d.J. received unrestricted research grants from Galapagos, Norgine, Vedanta and Nestle, including speaker’s fees from Galapagos, Tramedico, Takeda, and Janssen Pharmaceuticals. R.L. has received travel expenses and speaker’s fees from Cablon Medical. A.A.v.B. has received speaker’s fees and research grants from AbbVie, Arandal, Arena, Celgene, Ferring, Janssen, MSD, Pfizer, Roche, Takeda, TEVA, ZonMW and Eurostars funding. A.C.d.V. has received speaker’s fees and research grants from Janssen, Takeda, Abbvie and Tramedico. R.L.W. has received speaker’s fees and research grants from Jansen, Pfizer, and Abbvie. T.E.H.R. has received speaker’s fees from Takeda. F.D.M.v.S. has served on the advisory boards of Dr Falk, Takeda, and Galapagos. F.H. has received speaker’s fees or served on advisory boards for Abbvie, Celgene, Janssen-Cilag, MSD, Takeda, Celltrion, Teva, Sandoz and Dr Falk, and has received unrestricted grants from Dr Falk, Janssen-Cilag, Abbvie. Z.M. has received unrestricted grants from Niels Stensen Fellowship, MLDS, and Galapagos. All other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Prescribed oral and intravenous iron dose in patients with Inflammatory Bowel Disease. (A) Depicts the prescribed oral iron dosage. (B) Depicts prescribed intravenous iron dosage. The represented data are based on patient data extracted from medical records.
Figure 2
Figure 2
Respondent data regarding profession, place of employment, and screening for anemia and iron deficiency in patients with Inflammatory Bowel Disease. (A) Percentages indicating respondents’ profession. (B) Percentages indicating respondents’ place of employment. (C) Percentage of respondents and the parameters used to screen for anemia and iron deficiency in patients with quiescent Inflammatory Bowel Disease. (D) Percentage of respondents and the frequency of screening for anemia and iron deficiency in patients with quiescent Inflammatory Bowel Disease. (E) Percentage of respondents and the parameters used to screen for anemia and iron deficiency in patients with active Inflammatory Bowel Disease. (F) Percentage of respondents and the frequency of screening foranemia and iron deficiency in patients with active Inflammatory Bowel Disease. Hb: hemoglobin, MCV: Mean Corpuscular Volume.
Figure 3
Figure 3
Respondent data regarding the treatment of iron deficiency with or without anemia in patients with Inflammatory Bowel Disease. (A) Percentage of respondents prescribing treatment for asymptomatic anemia. (B) Percentage of respondents prescribing treatment for symptomatic anemia. (C) Percentage of respondents prescribing treatment for iron deficiency without anemia. (D) Percentage of respondents and their chosen therapy for iron-deficiency anemia in quiescent IBD. (E) Percentage of respondents and their chosen therapy for iron-deficiency anemia in active IBD. (F) Percentage of respondents and their chosen therapy for iron deficiency without anemia. Hb: hemoglobin.
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