IDDF2018-ABS-0075 Management of anaemia in inflammatory bowel disease

Abstract

Background Anaemia is the most common extraintestinal manifestation of IBD. It has a substantial impact on patients‘ morbidities and healthcare costs. Methods We conducted a retrospective observational study on all our patients (total numbers: 224) suffering from IBD to determine whether anaemia was addressed during their clinic visits and whether treatment(s) were appropriately given. The haemoglobin, mean cell volume (MCV), ferritin, total iron binding capacity (TIBC), iron saturation (in%) and CRP were reviewed. Results Among the total 132 (59%) Ulcerative colitis (UC) patients and 92 (41%) Crohn’s disease (CD) patients, 91 (40%) patients suffered from anaemia at diagnosis. 93 (42%) patients had ferritin, TIBC and iron saturation reviewed and documented. 71 (32%) patients received iron supplements at some point since the diagnosis of IBD was made. All patients with iron deficiency anaemia were correctly identified and were offered iron supplements. However, of those suffered from iron deficiency anaemia, only 24 (34%) patients had their ferritin, TIBC and iron saturation monitored every three months after adequate replacement to prevent recurrent iron deficiency. 25/91 (28%) of IBD patients suffered from non-iron deficiency anaemia (NIDA): 9 patients suffered from B12 deficiency and were all offered a parenteral replacement, 16 patients were given the diagnosis of anaemia of chronic disease (ACD), who demonstrated clinical or biochemical evidence of inflammation. During their most recent clinic visits, all patients had their haemoglobin reviewed and 47 (21%) patients still suffered from anaemia. 10/47 (22%) were non-compliant with their iron supplements; 16/47 (34%) were due to active inflammation; the rest did not have a clear diagnosis. Conclusions The aetiology of anaemia in IBD patients were mainly categorised into iron deficiency anaemia and NIDA. Adequate iron replacement and compliance are important in the treatment of iron deficiency. Recurrence of iron deficiency can be prevented by monitoring blood counts, ferritin, TIBC and iron saturation every three to six months. NIDA requires further work-up, and optimisation of IBD treatment should be first considered especially in ACD. In patients with persistent anaemia despite iron replacement and optimised IBD treatment, one should consider the use of erythropoiesis-stimulating agents.