Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience

ARTICLE HIGHLIGHTS

Research background

Screening for iron deficiency anemia (IDA) is uniformly recommended but may not always occur in the management of pediatric patients with acute exacerbation of their inflammatory bowel disease (IBD). In addition, clinicians may be hesitant to use intravenous (IV) iron in practice in the active IBD population due to concerns about adverse reactions reported in prior IV formulations. Our study sought to evaluate the efficacy and safety profile of IV iron therapy in pediatric patients with IDA admitted to our tertiary care center for their active IBD.

Research motivation

The significance of this research is that it provides additional data on the efficacy and safety profile of the newer IV iron preparations in pediatric patients with active IBD. This research will provide data in directing management of pediatric patients with IDA and active IBD.

Research objectives

The primary aim of this observational study was to prospectively evaluate the efficacy and safety of IV iron therapy for managing IDA in pediatric patients admitted to our center to manage clinical exacerbation of their IBD. The significance of achieving these objectives will allow providers caring for such patients to know the efficacy and safety profile of the newer iron preparations and possible expected outcomes.

Research methods

We performed a prospective, open-label, observational cohort study to evaluate our study aims. Research Study Coordinators reviewed the inpatient census daily to assess patient laboratory studies. They notified clinical staff of patients meeting the criteria for iron deficiency and provided them with information about the IV iron formulations available on the hospital formulary and dosing guidelines using a standardized electronic template. The inpatient team subsequently made all decisions concerning the preparation and dose of IV or oral iron prescribed for individual patients. The observational longitudinal cohort design allows us to evaluate changes in hemoglobin (Hb) and iron levels over time in individuals and groups of patients.

Research results

First, we found that IV iron is more efficacious than oral or no iron therapy in increasing Hb levels by their first ambulatory follow-up after receipt of iron therapy. This suggests that IV iron therapy is a more efficacious option in elevating Hb levels by the time of first ambulatory follow-up. Second, we found that IV iron was overall a safe option in the repletion of IDA in this pediatric IBD population with only 1/57 adverse events reported. This suggests that IV iron is a safe option in this patient population. Third, IDA did not resolve in patients who had otherwise responded favorably (comparable decreases in erythrocyte sedimentation rate and C-reactive protein levels) to medical therapy. In contrast to previous tenets suggesting that iron deficiency would resolve when the underlying inflammation was corrected, our data suggest that in the absence of targeted iron therapy, correction of the underlying inflammatory response is insufficient to resolve iron homeostasis in patients with IBD.

Research conclusions

Our single-center study shows that IV iron is safe and efficacious in treating IDA in children with active IBD. Our data further demonstrate that addressing inflammation is insufficient to correct iron deficiency and that successful treatment of iron deficiency in pediatric patients with IBD warrants active management.

Research perspectives

More extensive prospective studies are needed to investigate further the efficacy and safety of IV iron therapy in IDA in children with IBD.