Treatment of iron deficiency in pediatric patients with inflammatory bowel disease
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Iron deficiency anemia (IDA) is the most common extraintestinal complication encountered in patients with Inflammatory Bowel Disease (IBD), and it is more prevalent in pediatric patients compared to adults (Rogler and Vavricka). The inflammation and blood loss from the disease impacts both the absorption and storage of iron in the body (Rogler and Vavricka). With the intent of establishing a standard of care for IDA treatment in patients with IBD, we conducted a prospective study of 104 consecutive pediatric patients to assess the safety and efficacy of intravenous (IV) iron therapy compared to oral therapy and no treatment, as well as the effects of iron therapy on patient quality of life. Efficacy was assessed by comparing the change in hemoglobin levels in the interval between admission to outpatient follow-up. The average time to the first ambulatory follow-up was 29.08 days. 69 patients received IV iron therapy, 17 patients received oral iron supplementation, and 18 patients had no treatment. Treatment with IV iron resulted in a statistically significant increase in hemoglobin levels (2.00 g/dL ± 1.57 g/dL, as mean ± standard deviation) from admission to the first follow-up ambulatory appointment (p < .0001). Patients receiving IV iron therapy also experienced a significantly greater mean increase in hemoglobin levels than those treated with oral iron (p = .0084) or no treatment (p = .0018). Further, patients treated with IV iron experienced a significant increase in their quality of life at follow-up compared to admission as measured by the Impact-III questionnaire (p = .0179). Our study illustrates the importance of screening pediatric patients with IBD for IDA and suggests that IV iron treatment is safe and more effective in raising hematologic and iron measures than orally- administered alternative options.