P068 Erythrocyte and reticulocyte parameters in children with inflammatory bowel diseases

Abstract

Abstract Background Anaemia is a frequent extraintestinal manifestation of inflammatory bowel diseases (IBD) and its severity leads to a deterioration in patient’s condition. Timely diagnosis and pathogenetic therapy are important for the effective treatment. The aim of this study was to evaluate the current cell indexes obtained from automatic blood analyser to identify the pathogenetic features of anaemia in children with IBD. Methods A total of 1400 blood samples were analysed in 420 children with IBD (177—Crohn’s disease (CD) and 243—ulcerative colitis (UC)) followed up in our centre in 2018–2019. A blood test was performed by flow hemocytometry on an automatic blood analyser Sysmex XN 1000. The evaluated parameters were: MCV, MCH, MCHC, RET, IFR and RET-He. Anaemia was established with haemoglobin level <110 g/l. Clinical activity was evaluated according PUCAI (UC) and PCDAI (CD) scores. Results Anaemia was detected in 31.7% of patients with UC and in 26.8% of patients with CD. Decreasing of Hb level was observed in both diseases with an increasing in the clinical activity. The average Hb levels in CD in remission, moderate and severe activity were 132.15 ± 17.07, 120.51 ± 18.28 and 105.06 ± 12.46 g/l, respectively; in children with UC with remission, minimal, moderate and severe activity 124.86 ± 16.01; 114.53 ± 15.56; 109.71 ± 20.34 and 96.09 ± 16.52 g/l, respectively. In patients with CD, anaemia was predominantly hypochromic: the average values of MCV, MCH and RET-He indicates a leading role the bioavailable iron deficiency and corresponded to those in CD remission: 82.8 ± 7.0 fl, 27.35 ± 3.02 pg and 31.28 ± 3.82 pg; in low/moderate CD activity: 78.93 ± 7.49 fl, 25.29 ± 3.51 pg, 28.62 ± 5.1 pg; in high CD activity: 74.7 ± 6.74 fl, 22.99 ± 2.69 pg, 27.14 ± 4.99 pg, respectively. RET count in CD was moderate and equal 58–68 cell/ml. With an increase in the UC process activity, hypochromia was not enhanced: MCV in the range 79–82 fl, MCH—25–26 pg. RET-He in remission of UC were 30.22 ± 3.95 pg; in minimal activity—28.93 ± 4.96 pg; in moderate activity—27.99 ± 4.62 pg and only with high activity of UC there was a decreasement to 25.21 ± 4.99 pg. In UC the level of RET and IFR increases with increasing severity of the disease: 57.75 ± 17.48‰, 63.31 ± 31.12‰, 77.29 ± 41.81‰, 111.29 ± 78,9‰ and IFR 11.62 ± 5.235%, 15.69 ± 8.065%, 18.97 ± 8.385%, 26.97 ± 9.785%, respectively. This suggests that anaemia in UC is mainly associated with blood loss. Conclusion Anaemia in different forms of IBD in children has different pathogenetic mechanisms. Evaluation of current parameters of red blood cells by modern automatic blood count analyser is cheap and informative for the differential diagnosis of anaemic syndrome in children with IBD.