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World J Gastroenterol. Oct 7, 2009; 15(37): 4666-4674
Published online Oct 7, 2009. doi: 10.3748/wjg.15.4666
Intravenous iron in inflammatory bowel disease
Manuel Muñoz, Susana Gómez-Ramírez, José Antonio García-Erce
Manuel Muñoz, Transfusion Medicine, School of Medicine, University of Málaga, Málaga 29071, Spain
Susana Gómez-Ramírez, Department of Internal Medicine, University Hospital Virgen de la Victoria, Málaga 29010, Spain
José Antonio García-Erce, Department of Hematology and Hemoterapy, University Hospital Miguel Servet, Zaragoza 50008, Spain
Author contributions: Muñoz M, Gómez-Ramírez S, García-Erce JA contributed equally to this work.
Correspondence to: Manuel Muñoz, Professor, Transfusion Medicine, School of Medicine, University of Málaga, Málaga 29071, Spain. mmunoz@uma.es
Telephone: +34-952-131540 Fax: +34-952-131534
Received: July 23, 2009
Revised: September 17, 2009
Accepted: September 24, 2009
Published online: October 7, 2009
Abstract

The prevalence of anemia across studies on patients with inflammatory bowel disease (IBD) is high (30%). Both iron deficiency (ID) and anemia of chronic disease contribute most to the development of anemia in IBD. The prevalence of ID is even higher (45%). Anemia and ID negatively impact the patient’s quality of life. Therefore, together with an adequate control of disease activity, iron replacement therapy should start as soon as anemia or ID is detected to attain a normal hemoglobin (Hb) and iron status. Many patients will respond to oral iron, but compliance may be poor, whereas intravenous (IV) compounds are safe, provide a faster Hb increase and iron store repletion, and presents a lower rate of treatment discontinuation. Absolute indications for IV iron treatment should include severe anemia, intolerance or inappropriate response to oral iron, severe intestinal disease activity, or use of an erythropoietic stimulating agent. Four different products are principally used in clinical practice, which differ in their pharmacokinetic properties and safety profiles: iron gluconate and iron sucrose (lower single doses), and iron dextran and ferric carboxymaltose (higher single doses). After the initial resolution of anemia and the repletion of iron stores, the patient’s hematological and iron parameters should be carefully and periodically monitored, and maintenance iron treatment should be provided as required. New IV preparations that allow for giving 1000-1500 mg in a single session, thus facilitating patient management, provide an excellent tool to prevent or treat anemia and ID in this patient population, which in turn avoids allogeneic blood transfusion and improves their quality of life.

Keywords: Inflammatory bowel disease; Anemia; Iron deficiency; Functional iron deficiency; Erythropoiesis stimulating agents; Oral iron; Intravenous iron