Iron Deficiency in Patients with Inflammatory Bowel Disease (IBD)

Introduction: Anemia and iron deficiency are the most common extra-intestinal complications in IBD. Iron deficiency may be found in patients with normal hemoglobin levels, and it is the preface of anemia. Iron deficiency causes fatigue and is frequently associated with a reduced quality of life. This study aimed to determine the proportion of non-anemic IBD patients with iron deficiency and examine possible associations between iron deficiency and socio-demographic and clinical characteristics. Methods: Patients with confirmed diagnosis of IBD were recruited. Demographic and medical data were obtained. A total of 55 patients aged ≥18 y/o were included; 45 had Crohn's disease (CD) and 10 had Ulcerative colitis (UC). Patients with normal hemoglobin levels (defined by the World Health Organization as hemoglobin >13 g/dL in males, and >12 g/dL in females), were screened for iron deficiency using a combination of serum iron, ferritin, transferrin saturation and C-reactive protein (CRP). Among patients with normal CRP, iron deficiency was considered if serum ferritin was < 30 ng/mL or transferrin saturation was < 16%. Among patients with elevated CRP, iron deficiency was considered if serum ferritin was < 100 ng/mL. The data was stratified according to Iron Deficiency status. T-test was used to compare the mean duration of the disease between groups. Results: Iron deficiency without anemia was found in 89.1% of patients. Thirty-seven percent (37.0%) of the patients with iron deficiency were female and 63.3% male. However, 100% of female patients were iron deficient. The age of the majority of patients with iron deficiency (49%) was 20-34 years. Iron deficiency was identified in 81.6% of the patients with CD and 18.4% in patients with UC. Among patients with Crohn's and UC with iron deficiency, the most frequent disease locations were the small bowel and pancolitis, respectively. A marginally significant difference was observed in years of duration of disease and iron deficiency (p = 0.09). Those with iron deficiency showed in average 9.6±0.9 years (95% CI: 7.74-11.45) and their counterpart 6.8±1.2 years (95% CI: 3.76-9.90). Conclusion: A high proportionof non-anemic patients with iron deficiency was identified. Assessment of the iron status is imperative in order to institute early recognition and treatment, which may prevent iron deficiency anemia and improve quality of life. The sample size was small; larger studies are required to confirm these results.