Prevalence and type of anemia in IBD children at the time of diagnosis


Authors: A. Šuláková 1;  O. Pozler 2;  Nováčková L.† 3;  D. Šalounová 4
Authors‘ workplace: Klinika dětského lékařství, FN Ostrava, přednosta doc. MUDr. M. Hladík, Ph. D., Dětská klinika, FN Hradec Králové , přednosta prof. MUDr. M. Bayer, CSc., Ústav klinické biochemie, FN Ostrava , přednosta RNDr. Z. Švagera, Ph. D., Ekonomická f 1
Published in: Čes-slov Pediat 2012; 67 (1): 3-10.
Category: Original Papers

Overview

Introduction:
Prevalence of anemia in inflammatory bowel disease (IBD) is high and it has an important impact of anemia on the quality of life, morbidity and mortality in these patients. Iron deficiency (ID), iron deficiency anemia (IDA), anemia of chronic disease (ACD) and combination of both of these conditions represent the most frequent causes. It can be difficult to distinguish ID in condition of inflammation. In fact, the common diagnostic test (iron, ferritin and transferin saturation) are significantly influenced by inflammation and normal ferritin concentration does not exclude ID. In this case soluble transferin receptor (sTfR) and calculated sTfR/F index (sTfR/log ferritin) can improve ID diagnose.

Objective:
The aim of the study was: 1. to determine the total prevalence of anemia, 2. to determine the prevalence of the types of anemia (IDA, ACD, ACD/ID), and 3. to compare common laboratory test against sTfR and calculated sTfR/F index in diagnosis of iron deficiency in children at IBD onset.

Methods:
Fifty-six patients with newly diagnosed IBD fulfilled the inclusion criteria in the period from January 2005 to December 2009: newly diagnosed IBD and upper age limit 19 years. In all patients were examined red blood count, serum iron, total iron binding capacity, ferritin, sTfR and calculated sTfR/F index. C-reactive protein >5 mg/l was determined as a marker for inflammation. Anemia was defined by hemoglobin value <-2 SD considering age and sex. Anemic patients were divided in three groups (IDA, ACD, ACD/ID) according to the results of common tests and sTfR and sTfR/F. Both methods were subsequently compared.

Results:
Anemia was detected in 66.1% patients; significantly more frequent in Crohn’s disease (CD, 77.5%) and more frequent type of anemia were ACD and ACD/ID. Prevalence of anemia in ulcerative colitis (UC) patients was 37.5%, and there was detected only IDA. The difference in prevalence of IDA, ACD/ID and ACD between CD and UC was statistically significant. The agreement between both diagnostic methods was statistically significant in IDA (p<0.0001), the agreement in ACD/ID was reached in case of ferritin value <30 µg/l.

Conclusion:
The prevalence of anemia in IBD children is high at the onset of the disease. Soluble TfR measurement and sTfR/F index calculation can improve ID diagnosis in condition of chronic inflammation.

Key words:
anemia of chronic disease, iron deficiency anemia, iron deficiency, soluble transferin receptor, ferritin, children, inflammatory bowel disease


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Neonatology Paediatrics General practitioner for children and adolescents

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