Anemia in inflammatory bowel disease – the role of recombinant human erythropoietin

Abstract

Anemia is a common problem in inflammatory bowel disease (IBD). It is related to low Karnofsky scores, loss of weight, impaired physical activity, low tolerance to the underlying disease, and a poor growth rate in children. Multiple factors can contribute to the anemia in IBD, such as iron, folic acid or B 12 deficiency, treatment with immunosuppressive drugs or sulfasalazine, hemolysis, and anemia of chronic disease. Anemia of chronic disease is characterized by impaired iron utilization, lower erythropoietin (EPO) production than needed, and a low response of bone marrow erythroid progenitor cells to EPO. In recent years, recombinant human erythropoietin (rhEPO) has been used in combination with iron for the correction of refractory anemia in IBD patients (adults or children) with good results. There is increasing evidence that rhEPO may correct refractory anemia in IBD (both ulcerative colitis (UC) and Crohn’s disease (CD)). In addition, such therapy may give IBD patients the opportunity to predonate blood before surgery and to avoid blood transfusions. One must not forget to exclude or correct other causes of anemia in IBD patients before administering rhEPO. Furthermore, the enhancement of erythropoiesis by EPO makes it mandatory to administer oral or intravenous iron supplementation during therapy to meet the increased demand. rhEPO is safe in IBD patients. Further studies with larger numbers of patients are needed to optimize the therapy with rhEPO in the refractory anemia of IBD.