Anemia is one of the commonest extraintestinal manifestations of
inflammatory bowel disease (IBD). The pathogenesis of
anemia in IBD is complex but
iron deficiency combined with
inflammation is the most common factor related to the development of
anemia. However, other causes such as
vitamin B12 and
folate deficiency,
hemolysis, myelosuppression and
drug also should not be overlooked. In addition to
ferritin, inflammatory markers and new biochemical parameters such as
hepcidin and
ferritin index are being tested as diagnostic a tool. First step for treatment is disease activity control and
iron supplementation. Although oral
iron is widely used, intravenous
iron therapy should be considered in patients who are intolerant to oral
iron therapy, have severe and
refractory anemia or are in active disease state. Recently, new intravenous
iron formulations have been introduced and due to their safety and easy usage, they have become the standard treatment modality for managing
anemia in IBD.
Erythropoietin and transfusion can be considered in specific situations.
Vitamin B12 and
folate supplementation is also important in patients who are deficient of these
micronutrients. Since
anemia in IBD patients could significantly influence the disease outcome, further studies and standard guideline for IBD are needed.