Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Mar 9, 2024; 13(1): 89318
Published online Mar 9, 2024. doi: 10.5409/wjcp.v13.i1.89318
Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience
Krishanth Manokaran, Jonathan Spaan, Giulio Cataldo, Christopher Lyons, Paul D Mitchell, Tatyana Sare, Lori A Zimmerman, Paul A Rufo
Krishanth Manokaran, Jonathan Spaan, Giulio Cataldo, Christopher Lyons, Tatyana Sare, Lori A Zimmerman, Paul A Rufo, Center for Inflammatory Bowel Disease, Boston Children's Hospital, Boston, MA 02115, United States
Paul D Mitchell, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA 02115, United States
Co-first authors: Krishanth Manokaran and Jonathan Spaan.
Author contributions: Manokaran K and Spaan J contributed equally to this work; Rufo PA conceptualized the study; Rufo PA, Manokaran K, and Spaan J conceived methodology; Mitchell PD performed formal statistical analysis; Manokaran K, Spaan J, Cataldo G, and Lyons C performed data collection; Manokaran K, and Spaan J prepared original draft; Rufo PA, Mitchell PD, and Zimmerman LA helped review and edit manuscript; Rufo PA and Sare T provided resources and project administration; All authors have read and agree to the published version of the manuscript.
Institutional review board statement: This study was review and approved by the Boston Children's Hospital Institutional Review Board, No. P00024515.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Paul.Rufo@childrens.harvard.edu. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paul A Rufo, MD, Assistant Professor, Center for Inflammatory Bowel Disease, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States. paul.rufo@childrens.harvard.edu
Received: October 27, 2023
Peer-review started: October 27, 2023
First decision: December 17, 2023
Revised: January 7, 2024
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: March 9, 2024
Abstract
BACKGROUND

Screening for iron deficiency anemia (IDA) is important in managing pediatric patients with inflammatory bowel disease (IBD). Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous (IV) iron to treat IDA in this population.

AIM

To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.

METHODS

A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019. 92 patients met study criteria for IDA, of which 57 received IV iron, 17 received oral iron, and 18 were discharged prior to receiving iron therapy.

RESULTS

Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9 (± 0.2) g/dL in mean (± SE) hemoglobin (Hb) concentration by the first ambulatory follow-up, compared to patients who received oral iron 0.8 (± 0.3) g/dL or no iron 0.8 (± 0.3) g/dL (P = 0.03). One out of 57 (1.8%) patients that received IV iron therapy experienced an adverse reaction.

CONCLUSION

Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.

Keywords: Iron deficiency anemia, Pediatric inflammatory bowel disease, Intravenous iron therapy, Inflammatory bowel disease

Core Tip: In summary, in our single center study, we found oral iron generally ineffective in pediatric patients with inflammatory bowel disease and active inflammation. Parenteral iron met the primary clinical goal of the study (a 1g/dL increase in hemoglobin). Addressing inflammation without targeted therapy for iron deficiency is unlikely to correct the anemia associated with iron deficiency.