Анемия при воспалительных заболеваниях кишечника: патофизиология, диагностика и лечение

Abstract

Anaemia is a common secondary syndrome in gastroenterological diseases. Anaemia in patients with inflammatory bowel disease (IBD) is observed in two thirds of patients, which significantly affects the quality of life. Anaemia in IBD has a complex pathogenesis. The most common types of anaemia in patients with IBD are iron deficiency anaemia (IDA) and anaemia of chronic disease, which are often combined. In most cases, laboratory tests can successfully diagnose iron deficiency, in cases when difficulties with differential diagnosis arise, the recently established indicators can be used, such as the soluble transferrin to ferritin ratio or the percentage of hypochromic red blood cells. In the treatment of IDA in patients with IBD, it is very important both to control intestinal inflammation and to correct iron deficiency. Oral iron supplements can be used in patients with mild anaemia and without inflammatory activity, but intravenous iron infusion should be chosen as a first line therapy in patients with haemoglobin < 10 g/dl, in patients with active IBD, in patients with intolerance of oral drugs, and in cases when a fast response is not required. Erythropoietin is needed (in combination with intravenous iron infusion) in patients with anaemia to manage functional iron deficiency, while blood transfusion is restricted to refractory cases or acute, life-threatening conditions. Key words: anaemia, inflammatory bowel disease, iron deficiency anaemia, iron supplements, pathogenesis of anaemia