Anemia In Ulcerative Colitis Research Articles

The effects of spirulina supplementation on serum iron and ferritin, anemia parameters, and fecal occult blood in adults with ulcerative colitis: A randomized, double-blinded, placebo-controlled trial

The present clinical trial aimed to evaluate the efficacy of spirulina administration on serum iron, ferritin, anemia parameters, and fecal occult blood test (FOBT) in adults with ulcerative colitis (UC). Eighty participants with UC were randomly assigned to take, either 1g/day (two 500mg capsules) spirulina (n=40) or placebo (n=40) in a double-blinded clinical trial for eight weeks. Dietary intake, physical activity status, serum iron and ferritin levels, anemia parameters, and FOBT were assessed in each participant at baseline and following the intervention. Seventy-three participants completed the trial. Our results indicated significantly increased (p=0.04) serum iron after eight weeks of spirulina supplementation compared to the placebo group. The spirulina group also demonstrated significantly increased mean corpuscular volume (p=0.004) whereas red blood cell count (p=0.01) and hematocrit (p=0.03) were significantly lowered in the placebo group. No significant changes in FOBT outcomes were seen between groups at baseline (p=0.12) and the end of the trial (p=0.34). Eight weeks of 1g/day spirulina supplementation improved anemia parameters in adults with UC compared to placebo. These outcomes suggest that spirulina administration may be beneficial in the management of anemia in UC. Further clinical trials of longer duration are necessary to corroborate and expand our findings. Registered at: http://www.IRCT.ir (code: IRCT20170802035460N3).

Relationship between Undernutrition and Anemia in Patients with Ulcerative Colitis

This study aimed to assess the relationship between malnutrition and anemia in patients with ulcerative colitis (UC). The cross-sectional retrospective study included 80 patients with UC. Body mass index and total body fat mass were derived retrospectively from bioimpedance measurements. Anemia was diagnosed retrospectively according to WHO criteria. A binary logistic regression was performed to study the relationship between nutritional status parameters and anemia, and adjusted for demographic and disease-associated characteristics. The prevalence of anemia in the study population was 40.0%. Among all included patients, 86.3% had acute disease corresponding to S1–S3 disease behavior. In the adjusted binary logistic model, total serum protein level below 64 g/L and low body fat percentage were associated with high odds for the of development of anemia, with odds ratios of 5.1 (95% CI 1.5; 17.8; p = 0.01) and 8.5 (95% CI 1.1; 63.6; p = 0.037), respectively. The adjusted model included sex, age, disease activity, extent of gut involvement, quantity of relapses from disease onset, and treatment with immunosuppressive drugs as confounders. Hypoproteinemia and low body fat percentage were associated with anemia in patients with UC. These results suggested that undernutrition may be involved as one of the causative factors of anemia in UC.

Hereditary Spherocytosis as an Atypical Presentation of Anemia in Ulcerative Colitis

Anemia is encountered in up to two-thirds of all patients with inflammatory bowel disease (IBD). We are reporting a case of a 9-year-old female with history of very early onset IBD ulcerative colitis, and primary sclerosing cholangitis who was found to have hereditary spherocytosis as the etiology of her anemia. Despite good clinical response to IBD therapy, she continued to have persistent normocytic anemia. Liver biopsy and magnetic resonance cholangiopancreatography for uptrending liver transaminases demonstrated iron deposition which led to a T2-weighted magnetic resonance imaging study that quantified significant iron deposition in her liver and kidneys. Without any history of blood transfusions, these findings were concerning for hereditary hemochromatosis, but the hereditary hemochromatosis gene test was negative. Whole genome sequencing identified a pathogenic de novo variant consistent with hereditary spherocytosis. Table of Contents Summary: A novel presentation of anemia in inflammatory bowel disease

Intestinal iron absorption is appropriately modulated to match physiological demand for iron in wild-type and iron-loaded Hamp (hepcidin) knockout rats during acute colitis.

Mucosal damage, barrier breach, inflammation, and iron-deficiency anemia (IDA) typify ulcerative colitis (UC) in humans. The anemia in UC appears to mainly relate to systemic inflammation. The pathogenesis of this 'anemia of inflammation' (AI) involves cytokine-mediated transactivation of hepatic Hamp (encoding the iron-regulatory hormone, hepcidin). In AI, high hepcidin represses iron absorption (and iron release from stores), thus lowering serum iron, and restricting iron for erythropoiesis (causing anemia). In less-severe disease states, inflammation may be limited to the intestine, but whether this perturbs iron homeostasis is uncertain. We hypothesized that localized gut inflammation will increase overall iron demand (to support the immune response and tissue repair), and that hepatic Hamp expression will decrease in response, thus derepressing (i.e., enhancing) iron absorption. Accordingly, we developed a rat model of mild, acute colitis, and studied iron absorption and homeostasis. Rats exposed (orally) to DSS (4%) for 7 days had intestinal (but not systemic) inflammation, and biomarker analyses demonstrated that iron utilization was elevated. Iron absorption was enhanced (by 2-3-fold) in DSS-treated, WT rats of both sexes, but unexpectedly, hepatic Hamp expression was not suppressed. Therefore, to gain a better understanding of regulation of iron absorption during acute colitis, Hamp KO rats were used for further experimentation. The severity of DSS-colitis was similar in Hamp KOs as in WT controls. In the KOs, increased iron requirements associated with the physiological response to colitis were satisfied by mobilizing hepatic storage iron, rather than by increasing absorption of enteral iron (as occurred in WT rats). In conclusion then, in both sexes and genotypes of rats, iron absorption was appropriately modulated to match physiological demand for dietary iron during acute intestinal inflammation, but regulatory mechanisms may not involve hepcidin.

Advancement of Iron Deficiency Anemia in Ulcerative Colitis

Advancement of Iron Deficiency Anemia in Ulcerative Colitis

P068 Erythrocyte and reticulocyte parameters in children with inflammatory bowel diseases

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.

Anemia in inflammatory bowel diseases: the approaches to its diagnosis, treatment and prevention

Anemia is a frequent systemic complication and extra-intestinal manifestation of inflammatory bowel diseases (IBD). Despite significant progress in IBD treatment, late diagnosis and insufficient correction of concomitant anemia remain a problem in routine clinical practice. The review describes the main pathophysiological mechanisms of IBD-associated anemia, such as iron deficiency, chronic inflammation (anemia of chronic disease) and B9 and B12 deficiencies. The authors highlight the main diagnostic principles of these conditions, present the strategy for their differential diagnosis, describe the state-of-theart approaches to the correction of iron-deficient anemia in IBD, and delineate the role of oral and parenteral medications for replacement therapy. Optimal treatment goals and prevention methods of an iron-deficient condition are given. Special attention is focused on the principles on red cell mass transfusions in acute massive blood loss. The authors describe the main differentiating features of anemia of chronic disease and its treatment in IBD patients with various grades of the inflammation. The paper contains the indications and treatment regimens for B12 and foliate-deficient anemia with consideration of the IBD course. The authors of the article are members of the Working Group of the Russian Society on the study of IBD and believe that the literature analysis performed would allow for its use to issue the Russian clinical guidelines on the management of patients with anemia in ulcerative colitis and Crohn's disease.

Clinical outcomes and risk factors of secondary extraintestinal manifestation in ulcerative colitis: results of a multicenter and long-term follow-up retrospective study.

BackgroundExtraintestinal manifestations (EIM) are common in ulcerative colitis (UC). In Shanghai, China, data on the incidence rate and risk factors of EIM in UC patients remain scarce.MethodsThe study population consisted of UC patients who were identified from a prospectively maintained, institutional review board-approved database at our institutes from June 1986 to December 2018. The demographic and clinical characteristics of the study participants were analyzed. The study included secondary EIM in UC patients and follow-up, while primary EIM was excluded. The diagnosis of EIM was based on clinical, radiological, endoscopic, and immunologic examination and histological findings.ResultsIn total, 271 eligible patients were included in the current study, with a median follow-up time of 13.0 years (interquartile range, 9.0–17.0), and including 31 cases (11.4%) that developed EIM. EIM was associated with clinical outcomes in UC patients and the following factors were identified as contributing factors for the development of EIM: a disease duration of >5 years (odds ratio (OR), 3.721; 95% confidence interval (CI) [1.209–11.456]), age at diagnosis >40 years (OR, 2.924, 95% CI [1.165–7.340]), refractory clinical symptoms (OR, 4.119; 95% CI [1.758–9.650]), and moderate or severe anemia (OR, 2.592; 95% CI [1.047–6.413]).ConclusionIn this study, approximately 11.4% UC patients go on to develop at least one EIM. Clinicians should prioritize early control of the disease and treatment of anemia in UC in order to prevent the development of EIM and improve disease prognosis.

The Epidemiology of Anemia in Pediatric Inflammatory Bowel Disease

Anemia is poorly studied in pediatric inflammatory bowel disease. This study explored the epidemiology and associated factors of anemia at diagnosis, after 1 year, and during treatment with exclusive enteral nutrition (EEN). Three cohorts were included: (1) a representative population of newly diagnosed inflammatory bowel disease children (n = 184); (2) patients currently receiving care with data available at diagnosis (n = 179) and after 1 year (n = 139); and (3) 84 children treated with EEN. At diagnosis, 72% were anemic. Abnormal inflammatory markers were more common in Crohn's disease with severe anemia (severe versus no anemia [%]: raised C-reactive protein; 89% versus 48%; suboptimal albumin; 97% versus 29%; P < 0.002). Anemic children with Crohn's disease had shorter diagnosis delay and lower BMI than nonanemic patients (severe versus mild versus no anemia, median [interquartile range]; diagnosis delay [months]: 3 [3.9] versus 6 [10] versus 8 [18], P < 0.001; BMI z score [SD]: -1.4 [1.4] versus -1.3 [1.5] versus -0.2 [1.4], P = 0.003). Extensive colitis was associated with severe anemia in ulcerative colitis. The proportion of severely anemic patients decreased from 34% to 9% and mild anemia doubled at 1 year. After EEN, severe anemia decreased (32% to 9%; P < 0.001) and the hemoglobin concentration increased by 0.75 g/dL. This was observed only after 8 weeks of treatment. Disease improvement and low hemoglobin at EEN initiation but not weight gain were associated with hemoglobin improvement. Anemia is high at diagnosis and follow-up and should receive more attention from the clinical team; however, the focus should remain suppression of inflammatory process in active disease.

Predictors of corticosteroid‐dependent and corticosteroid‐refractory inflammatory bowel disease: analysis of a Chinese cohort study

Patients with inflammatory bowel disease (IBD) who are corticosteroid-dependent or -refractory are at higher risk of developing disease- and treatment-related complications. To identify retrospectively clinical factors present at diagnosis that predict the occurrence of corticosteroid dependency and refractoriness in Crohn's disease (CD) and ulcerative colitis (UC) patients. A total of 310 IBD patients (134 CD, 176 UC) were observed for 2140 person years and their use of systemic corticosteroids was determined. Outcomes of corticosteroid dependency and refractoriness were recorded. Univariate and multivariate analyses were performed to determine the clinical factors associated with outcomes. Seventy-seven (57.5%) CD and 95 (54.0%) UC patients had received corticosteroids during study period. In CD, thrombocytosis [Hazard ratio (HR):3.0] predicted, whereas colonic CD (HR:0.3) negatively predicted corticosteroid dependency. Stricturing phenotype (HR:4.5) predicted corticosteroid-refractory CD. For UC, thrombocytosis (HR:3.9) and extensive colitis (HR:1.7) predicted corticosteroid dependency. Presence of anaemia (HR:10.8) at diagnosis and initial requirement of total parenteral nutrition (TPN) (HR:18.8) predicted corticosteroid-refractory UC. The cumulative risks of surgery were 17.8% and 5.4% for CD and UC patients respectively at 1 year after starting corticosteroids. Thrombocytosis at diagnosis predicted corticosteroid-dependency in IBD. Stricturing phenotype of CD and the presence of anaemia in UC predicted subsequent course of corticosteroid refractoriness.

Coombs‐positive Autoimmune Haemolytic Anemia in Ulcerative Colitis: Spectrum of Same Disease?

Hae Ulcerative Colitis (UC) is known to be associated with autoimmune haemolytic anaemia (AIHA). This rare complication has been described in 0.2 to 0.7% of adult patients affected by UC. 1.82% of patients with UC have a positive direct Coombs test without evidence of haemolysis. The aetiology is not completely understood; colon seems to play a role in the production of anti-erythrocytes antibodies and sometimes colectomy is necessary to resolve refractory haemolisys in UC. We report a case of Coombs-positive haemolytic anemia (AIHA) refractory to steroids and immunoglobulin infusions (IVIG) in a child with severe UC. Case report: a 7-year-old patient with UC followed at GI Unit of Meyer Children Hospital of Florence, was admitted to our Clinic because of jaundice. He had a history of severe steroid-refractory UC which had been controlled with cyclosporine and azathioprine. At time of admission UC was in remission on azathioprine and mesalazine although mild intestinal bleeding was occasionally present. Examination revealed pallor, skin and scleral icterus, tachycardia, palpable splenic tip; laboratory tests revealed Coombs-positive haemolytic anemia. IVIG (1 gr/kg/day for 3 days) and oral prednisone (2 mg/kg/day) were prescribed with clinical improvement. The child was discharged with oral steroids and azathioprine. Four weeks later, while on oral steroids (1 mg/kg/day), the child had again haemolytic crisis refractory to IVIG (1 gr/kg/day for 3 days) and metylpredisone pulses. Colonscopy revealed active mucosal lesions. Cyclosporine was then introduced orally. On this treatment both AIHA and UC went in remission. To our knowledge this is the first reported case of the association of AIHA and UC in childhood. In our case the clinical course of AIHA and treatment response requiring immunosuppressive therapy seemed to be dependent on UC activity. Presumably the colon displays a role in the production of anti-erythrocyte antibodies.

Haemolytic anaemia in ulcerative colitis: Spectrum of same disease?

Haemolytic anaemia in ulcerative colitis: Spectrum of same disease?

Sequential Treatment of Anemia in Ulcerative Colitis with Intravenous Iron and Erythropoietin

Background: Intravenous iron and erythropoietin have been shown to be effective in Crohn’s disease-associated anemia. The aim of this study was to test the sequential treatment of anemia in ulcerative colitis with intravenous iron in the first phase and erythropoietin in the second. Patients and Methods: Twenty patients with ulcerative colitis-associated anemia (hemoglobin ≤10.5 g/dl) entered this open-label trial. In the first phase all patients received intravenous iron saccharate for 8 weeks. A response was defined as an increase in hemoglobin ≥2.0 g/dl; a final hemoglobin >10.5 g/dl was regarded as full response, ≤10.5 g/dl as partial response. A hemoglobin increase <2.0 g/dl was regarded as nonresponse. In the second phase (n = 4) erythropoietin was initiated in patients without response. Patients with partial response were continued on iron saccharate for another 8 weeks. Results: During the first phase the hemoglobin increased from 8.3 to 11.9 g/dl (mean hemoglobin difference 3.6 ± 2.3 g/dl, p < 0.001). Fifteen patients (75%) showed a full response (mean hemoglobin difference 4.5 ± 1.5 g/dl), 1 (5%) a partial response (hemoglobin difference 2.1 g/dl) and 4 no response (mean hemoglobin difference 0.4 ± 1.8 g/dl) with a need for blood transfusions in a single patient. In the second study phase erythropoietin was highly effective in previous nonresponders (mean hemoglobin difference 3.3 ± 1.9 g/dl). The single patient with partial response had a minor hemoglobin increase (hemoglobin difference 1.0 g/dl). Conclusion: Most patients with ulcerative colitis-associated anemia improve on intravenous iron alone. Erythropoietin is effective in those who do not respond.

An uncommon cause of anaemia in ulcerative colitis

A 56-year-old woman is reported with severe ulcerative colitis who developed a corticosteroid-resistant haemolytic anaemia. The pathogenesis and treatment options in ulcerative-colitis-related haemolytic anaemia are discussed.

High efficacy of iron saccharate infusions for anemia in ulcerative colitis: C. Dejaco, [formula omitted], W. Reinisch, W. Tillinger, H. Vogelsang, h. Lochs, A. Gangl. Dept. of Gastroenterology and Hepatology; University of Vienna, Austria

High efficacy of iron saccharate infusions for anemia in ulcerative colitis: C. Dejaco, [formula omitted], W. Reinisch, W. Tillinger, H. Vogelsang, h. Lochs, A. Gangl. Dept. of Gastroenterology and Hepatology; University of Vienna, Austria

Auto-Immune Haemolytic Anaemia in Ulcerative Colitis

We report 2 patients with auto-immune haemolytic anaemia (AIHA) complicating ulcerative colitis (UC), each with a hitherto undescribed feature. In the 1st case, direct antiglobulin test showed red cells coated with complement only, and the 2nd case was successfully treated with danazol. These 2 patients bring to 40 the number of cases of AIHA associated with UC. A review of the clinical details suggests that the patients may be divided into two distinct groups. In the first (4/40), AIHA seems to occur as an auto-immune event independent of the activity of UC; in the second group (36/40), AIHA is apparently dependent on active colitis, i.e. control of colitis is crucial to control haemolysis.

Autoimmune Hemolytic Anemia in Ulcerative Colitis A Case Report with Review of the Literature

Autoimmune hemolytic anemia is a rare complication of ulcerative colitis. This report chronicles a patient successfully treated with steroids, and reviews treatment in previously reported cases. The fact that 21% of patients recovered with steroid therapy encourages a conservative approach before surgery is considered.

Coombs-positive autoimmune hemolytic anemia in ulcerative colitis —A report of two cases—

Two cases of ulcerative colitis with a positive Coombs test are reported herein. In a 30 year old woman, hemolytic anemia was well controlled by excision of a rectal stump left over from a former operation. A 53 year old woman had a positive Coombs test without clinical hemolytic anemia 10 years after undergoing a total procto-colectomy with ileo-anal anastomosis. Thus we concluded that total procto-colectomy may be preventive, as well as therapeutic, for Coombs positive hemolytic anemia associated with ulcerative colitis.

Autoimmune Haemolytic Anaemia in Ulcerative Colitis

Autoimmune Haemolytic Anaemia in Ulcerative Colitis

Observations on the incidence and cause of anaemia in ulcerative colitis.

Observations on the incidence and cause of anaemia in ulcerative colitis.