Treatment targeting pediatric inflammatory bowel disease-associated anemia: experience from a single tertiary center.

Abstract

Background: Iron deficiency (ID) and iron deficiency anemia (IDA) are common complications of pediatric inflammatory bowel disease (IBD). Owing to questions regarding optimal iron formulation, dosage, route of administration, and safety, these complications are frequently overlooked and undertreated, negatively impacting patient development and quality of life.

Purpose: To assess the safety and efficacy of iron sucrose (IS) and ferric carboxymaltose (FCM) in the treatment of ID and IDA in pediatric IBD.

Methods: We retrospectively reviewed the medical records of pediatric patients with IBD treated for 10 years with IS (age < 14 years) or FCM (age ≥ 14 years) in a single regional referral center. The Ganzoni formula was used to calculate the iron dose administered. Adverse reactions were monitored during treatment and after discharge. Efficacy was defined as a ≥2 g/dL rise in Hb or anemia resolution within 12 weeks after treatment in cases of IDA and transferrin saturation or ferritin normalization in cases of ID.

Results: Sixty-three patients were treated with IV iron (41 with Crohn disease, 15 with ulcerative colitis, 7 with IBD-unclassified; median age, 14.6 years; 104 treatment courses [63 FCM, 41 IS during the 10-year study period]). Retreatment was necessary after a median 1.4 years in 26 patients (41.3 %). The median activity scores of patients with recurrent ID indicated inactive disease. The treatment efficacy was 66.7% (FCM) and 67.6% (IS) in patients with IDA and 77.8% in patients with ID but without anemia. One adverse reaction (hypotension and rash) was associated with IS treatment.

Conclusion: In one of the largest and longest follow-up cohorts, FCM and IS were safe and effective for correcting ID in pediatric patients with IBD. As ID recurs frequently, proactive screening and treatment are important.