Anemia, a common complication associated with
inflammatory bowel disease (IBD), is frequently overlooked in the management of IBD patients. Unfortunately, it represents one of the major causes of both decreased quality of life and increased hospital admissions among this population.
Anemia in IBD is pathogenically complex, with several factors contributing to its development. While
iron deficiency is the most common cause,
vitamin B12 and
folic acid deficiencies, along with the effects of pro-inflammatory
cytokines,
hemolysis,
drug therapies, and myelosuppression, have also been identified as the underlying etiology in a number of patients. Each of these etiological factors thus needs to be identified and corrected in order to effectively manage
anemia in IBD. Because the diagnosis of
anemia in IBD often presents a challenge, combinations of several hematimetric and biochemical parameters should be used. Recent studies underscore the importance of determining the
ferritin index and
hepcidin levels in order to distinguish between
iron deficiency anemia,
anemia due to
chronic disease, or mixed
anemia in IBD patients. With regard to treatment, the newly introduced intravenous
iron formulations have several advantages over orally-administered
iron compounds in treating
iron deficiency in IBD. In special situations,
erythropoietin supplementation and
biological therapies should be considered. In conclusion, the management of
anemia is a complex aspect of treating IBD patients, one that significantly influences the prognosis of the disease. As a consequence, its correction should be considered a specific, first-line therapeutic goal in the management of these patients.