Intravenous Iron Sucrose versus Oral Iron Supplementation for the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease—A Randomized, Controlled, Open-Label, Multicenter Study Ferric carboxymaltose prevents recurrence of anemia in patients with inflammatory bowel disease. High burden of iron deficiency and different types of anemia in inflammatory bowel disease outpatients in Scandinavia: A longitudinal 2-year follow-up study Safety and Efficacy of Total-Dose Infusion of Low Molecular Weight Iron Dextran for Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease Rapid Recurrence of IBD-Associated Anemia and Iron Deficiency After Intravenous Iron Sucrose and Erythropoietin Treatment Oral and intravenous iron treatment in inflammatory bowel disease: Hematological response and quality of life improvement Effect of Iron Therapy on Platelet Counts in Patients with Inflammatory Bowel Disease-Associated Anemia A Novel Intravenous Iron Formulation for Treatment of Anemia in Inflammatory Bowel Disease: The Ferric Carboxymaltose (FERINJECT®) Randomized Controlled Trial FERGIcor, a randomized controlled trial on ferric carboxymaltose for iron deficiency anemia in inflammatory bowel disease. Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia A 1-year trial of repeated high-dose intravenous iron isomaltoside 1000 to maintain stable hemoglobin levels in inflammatory bowel disease Recombinant human erythropoietin in patients with inflammatory bowel disease and refractory anemia: a 15-year single center experience. TREATMENT OF ANEMIA AND IMPROVEMENT OF QUALITY OF LIFE AMONG PATIENTS WITH CROHN'S DISEASE: experience using ferric carboxymaltose. Iron deficiency anemia and iron therapy effects on infant developmental test performance. Anemia in older persons: etiology and evaluation. Iron deficiency anemia: adverse effects on infant psychomotor development. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Geriatric Inflammatory Bowel Disease: Phenotypic Presentation, Treatment Patterns, Nutritional Status, Outcomes, and Comorbidity Iron treatment normalizes cognitive functioning in young women. Intravenous iron therapy restores functional iron deficiency induced by infliximab. Iron Deficiency Generates Secondary Thrombocytosis and Platelet Activation in IBD: the Randomized, Controlled ThromboVIT Trial [Diagnosis and therapy of iron deficiency anemia in pregnancy]. The impact of systematic dietary counseling during the first year of life on prevalence rates of anemia and iron deficiency at 12-16 months.
OBJECTIVES : Anemia is a frequent complication in patients with inflammatory bowel disease ( IBD ) . The optimal route for iron supplementation to replenish iron stores has not been determined so far . We therefore evaluated the efficacy and safety of intravenous iron sucrose as compared with oral iron sulfate for the treatment of iron deficiency anemia ( IDA ) in patients with IBD . METHODS : A r and omized , prospect i ve , open-label , multicenter study was performed in 46 patients with anemia and transferrin saturation ≤20 % and /or serum ferritin concentrations ≤20 μg/L. The intravenous group received a single dose of iron sucrose of 7 mg iron/kg body weight , followed by five 200 mg infusions for the following 5 wks . The oral group received iron sulfate 100–200 mg per day for 6 wks . RESULTS : While a comparable increase in hemoglobin was observed for both administration routes ( median increase 0.25 g/L in the intravenous group vs 0.21 g/L in the oral group ) , only iron sucrose led to a rise in serum ferritin concentrations . Intractable gastrointestinal adverse events caused permanent study drug discontinuation in five patients ( 20.8 % ) receiving iron sulfate , whereas only one patient ( 4.5 % ) had to be withdrawn because of side effects due to iron sucrose . CONCLUSIONS : Although being equal in short-term efficacy and overall tolerability our results suggest a better gastrointestinal tolerability for iron sucrose . Larger trials are m and atory to prove a possible advantage of iron sucrose in short- and long-term efficacy as well as in tolerability over iron sulfate in the management of IDA in IBD BACKGROUND & AIMS Iron-deficiency anemia is the most common systemic complication of inflammatory bowel diseases ( IBD ) . Iron-deficiency anemia recurs frequently and rapidly after iron-replacement therapy in patients with IBD . We performed a r and omized , placebo-controlled trial to determine if administration of ferric carboxymaltose ( FCM ) prevents anemia in patients with IBD and low levels of serum ferritin . METHODS We performed a single-blind , multicenter study of nonanemic patients who had completed the FERGIcor study .  Serum levels of ferritin were assessed every second month , and patients were given FCM ( total iron dose , 1181 ± 662 mg ; n = 105 ) or placebo ( n = 99 ) when levels decreased to less than 100 μg/L. The primary end point was time to recurrence of anemia within 8 months . Secondary end points included changes of quality of life , disease activity , results from laboratory tests , and adverse events . RESULTS Anemia recurred in 26.7 % of subjects given FCM and in 39.4 % given placebo . The time to anemia recurrence was longer in the FCM group ( hazard ratio , 0.62 ; 95 % confidence interval , 0.38 - 1.00 ; P = .049 ) . Markers of body levels of iron increased or remained at normal levels in subjects given FCM ( ferritin increased by 30.3 μg/L , transferrin saturation increased by 0.6 % ) but decreased in the group given placebo ( ferritin decreased by 36.1 μg/L , transferrin saturation decreased by 4.0 % ) . Changes in quality of life and disease activity were comparable between groups . Adverse events were reported in 59.0 % of the FCM group and 50.5 % of the placebo group , and serious adverse events were reported in 6.7 % and 8.1 % , respectively . CONCLUSIONS FCM prevents recurrence of anemia in patients with IBD , compared with placebo . Nevertheless , the high rate of anemia recurrence warrants optimization of the frequency and requirements for FCM treatment Abstract Objective . The prevalence of anemia in inflammatory bowel disease ( IBD ) has been broadly described . The recurrence , type and burden of anemia remain unenlightened . The primary objective was to describe this . The secondary objective was to evaluate the implementation of European guidelines . Material s and methods . This longitudinal follow-up study included 300 IBD out patients from six centers in Sc and inavia . Patients were enrolled in a research cohort , in which each center included 5 % of their IBD cohort . The study was prospect ively planned , while data were retrospectively collected . The burden of anemia was calculated as number of months with anemia . A Markov model was used to calculate the probabilities of transitioning between stages . The European guidelines were used as the st and ard for anemia management . Results . Anemia affected > 50 % of IBD out patients during the 2-year observation period . Totally , 20 % of the total observation time was spent in anemia . Over the 7200 months of observation , anemia was found in 1410 months . The most frequent type was combined anemia ( 63 % ) . Combined anemia covers both anemia of chronic disease ( ACD ) and iron-deficiency anemia ( IDA ) . Pure ACD was present in 21 % of burden time , while pure IDA was present in 16 % of burden time . The European guidelines have mainly been implemented . Conclusion . Anemia affected a majority of the IBD out patients . One in five months , the patients were anemic . Anemia related to inflammation dominated the different types of anemia . Pure IDA was found in for 16 % . These findings , despite a fair implementation of guidelines Background Intravenous iron has been suggested as a safe and effective treatment of anemia complicating inflammatory bowel disease ( IBD ) .  Low molecular weight ( LMW ) iron dextran has the ability to administer the patient ’s total iron requirement in a single infusion . Aims The aim of this study was to assess the safety and efficacy of the total dose of LMW iron dextran infusion for the treatment of iron deficiency in IBD . Methods Fifty IBD patients ( 27 female , 35 Crohn ’s disease , 15 ulcerative colitis ) were included in the study . Mean ± st and ard deviation ( SD ) hemoglobin and ferritin levels before the infusion were 9.88 ± 1.42 g/dl and 13.9 ± 10.9 ng/ml , respectively . A 25-mg test dose was followed by infusion of the total dose of LMW iron dextran based on the iron deficit . Several clinical and laboratory parameters were measured before and on week 4 after infusion . Results Four patients ( 8 % ) developed adverse reactions during the test infusion and did not receive the total-dose infusion . Only one patient developed an allergic reaction during the total-dose infusion . In the remaining 45 patients , the mean ± SD iron dose that was given was 1,075 ± 269 mg . The mean ± SD elevation of hematocrit and hemoglobin on week 4 was 4.9 ± 1.9 % and 1.7 ± 0.8 g/dl , respectively . Hematopoietic response was observed in 23 of 45 patients ( 51.1 % ) . Conclusion Total parenteral iron replacement with LMW iron dextran is an easy , safe , and effective alternative method for treating iron deficiency anemia in IBD . Harmless adverse reactions may develop in a minority of patients OBJECTIVES : Anemia is a common complication of inflammatory bowel disease ( IBD ) and iron deficiency ( ID ) is its predominant cause . Therefore , oral and intravenous iron replacements are widely used . This study was performed to evaluate the frequency and timing of anemia and ID recurrence after a successful treatment cycle . METHODS : Medical records of patients who had received iron sucrose with or without erythropoietin ( EPO ) in one of three prospect i ve clinical trials that had been conducted at our center ( Ann Intern Med 1997 , Digestion 1999 , and Am J Gastroenterol 2001 ) were analyzed for a 5-year follow-up period . The risk for recurrence of anemia ( hemoglobin (Hb)<12/13 g per 100 ml ) and ID ( ferritin < 30 μg/l ) was evaluated by Kaplan – Meier analysis using the log-rank test . RESULTS : Eighty-eight patients were available for analysis . Patients had received a mean iron dose of 2,500 mg ( range 600–3,600 mg ) ; 33 ( 37.1 % ) patients had also received EPO . Anemia recurred in a median of 10 months ( 95 % confidence interval ( CI ) 8–12 ) and ID recurred within 19 months ( 95 % CI 11–28 ) . The iron dose had no influence on recurrence of ID or anemia . ID ( but not anemia ) recurred faster in patients with a post-treatment ferritin level < 100 μg/l ( median 4 months , 95 % CI 1–7 ) than in patients with ferritin level between 100 and 400 μg/l ( median 11 months , 95 % CI 6–16 ) and > 400 μg/l ( median 49 months , 95 % CI 32–66 ; P<0.001 ) . CONCLUSIONS : IBD-associated ID and anemia recur surprisingly fast , indicating that maintenance treatment may be needed in a portion of the patient population . Recurrence of ID ( but not anemia ) can be delayed by aim ing for high post-treatment ferritin levels Background : The aim was to evaluate the efficacy and tolerance of oral and intravenous iron treatment in anemic inflammatory bowel disease ( IBD ) patients , considering both hematological and quality ‐of‐life outcomes . Methods : We performed a prospect i ve multicenter study in IBD patients with iron deficiency anemia . Patients having hemoglobin > 10 g/dL were prescribed oral ferrous sulfate . If hemoglobin < 10 g/dL , intravenous ( sucrose ) iron was administered . Oral iron‐intolerant patients were changed to intravenous treatment .  Clinical ( Truelove/Harvey – Bradshaw ) , hematological ( response defined as hemoglobin normalization ) , and quality ‐of‐life ( shortened CCVEII‐9 question naire ) evaluations were performed at baseline and at 3 and 6 months . Results : 100 IBD patients ( 59 Crohn 's disease , 41 ulcerative colitis ) were included . Mean basal hemoglobin levels were 10.8 ± 1.3 g/dL ( range , 6.6–12.9 ) . Seventy‐eight patients received oral treatment and 22 intravenous iron .  Hemoglobin normalization was achieved in 86 % of patients : 89 % with oral , and 77 % with intravenous iron . An IBD activity increase was not demonstrated in any patient . Four patients ( 5.1 % ) showed oral iron intolerance leading to discontinuation of treatment . No adverse events were reported for intravenous iron  . Hemoglobin correlated with CCVEII‐9 ( P < 0.001 ) . The CCVEII‐9 score increased in patients who normalized hemoglobin levels in 3 months ( from 58 ± 9 to 73 ± 10 ) or 6 months ( 54 ± 9 , 68 ± 12 , and 74 ± 10 ) ( P < 0.001 ) . Conclusions : Oral iron treatment is effective and well tolerated in most IBD patients , and does not exacerbate the symptoms of the underlying IBD . Intravenous iron , on the other h and , is an effective and safe alternative treatment for iron deficiency anemia in more severely anemic or intolerant patients . Anemia correction with iron treatment is associated with a relevant improvement in the patients ' quality of life . ( Inflamm Bowel Dis 2009 Background and Aims Secondary thrombocytosis is a clinical feature of unknown significance . In inflammatory bowel disease ( IBD ) , thrombocytosis is considered a marker of active disease ; however , iron deficiency itself may trigger platelet generation . In this study we tested the effect of iron therapy on platelet counts in patients with IBD-associated anemia . Methods Platelet counts were analyzed before and after iron therapy from four prospect i ve clinical trials . Further , changes in hemoglobin , transferrin saturation , ferritin , C-reactive protein , and leukocyte counts , before and after iron therapy were compared . In a subgroup the effect of erythropoietin treatment was tested . The results were confirmed in a large independent cohort ( FERGIcor ) . Results A total of 308 patient records were available for the initial analysis . A dose-depended drop in platelet counts ( mean 425 G/L to 320 G/L ; p<0.001 ) was found regardless of the type of iron preparation ( iron sulphate , iron sucrose , or ferric carboxymaltose ) . Concomitant erythropoietin therapy as well as parameters of inflammation ( leukocyte counts , C-reactive protein ) had no effect on the change in platelet counts . This effect of iron therapy on platelets was confirmed in the FERGIcor study cohort ( n=448 , mean platelet counts before iron therapy : 383 G/L , after : 310 G/L , p<0.001 ) . Conclusion Iron therapy normalizes elevated platelet counts in patients with IBD-associated anemia . Thus , iron deficiency is an important pathogenetic mechanism of secondary thrombocytosis in IBD BACKGROUND AIMS : Anemia is a common complication of inflammatory bowel diseases ( IBD ) This multicenter study tested the noninferiority and safety of a new intravenous iron preparation , ferric carboxymaltose ( FeCarb ) , in comparison with oral ferrous sulfate ( FeSulf ) in reducing iron deficiency anemia ( IDA ) in IBD . METHODS : Two hundred patients were r and omized in a 2:1 ratio ( 137 FeCarb:63 FeSulf ) to receive FeCarb ( maximum 1,000 mg iron per infusion ) at 1-wk intervals until the patients ' calculated total iron deficit was reached or FeSulf ( 100 mg b.i.d . ) for 12 wk . The primary end point was change in hemoglobin ( Hb ) from baseline to week 12 . RESULTS : The median Hb improved from 8.7 to 12.3 g/dL in the FeCarb group and from 9.1 to 12.1 g/dL in the FeSulf group , demonstrating noninferiority ( P = 0.6967 ) . Response ( defined as Hb increase of > 2.0 g/dL ) was higher for FeCarb at week 2 ( P = 0.0051 ) and week 4 ( P = 0.0346 ) . Median ferritin increased from 5.0 to 323.5 μg/L at week 2 , followed by a continuous decrease in the FeCarb group ( 43.5 μg/L at week 12 ) . In the FeSulf group , a moderate increase from 6.5 to 28.5 μg/L at week 12 was observed . Treatment-related adverse events ( AEs ) occurred in 28.5 % of the FeCarb and 22.2 % of the FeSulf groups , with discontinuation of study medication due to AEs in 1.5 % and 7.9 % , respectively . CONCLUSIONS : FeCarb is effective and safe in  IBD-associated anemia  . It is noninferior to FeSulf in terms of Hb change over 12 wk , and provides a fast Hb increase and a sufficient refill of iron stores BACKGROUND & AIMS Iron deficiency anemia ( IDA ) is common in chronic diseases and intravenous iron is an effective and recommended treatment . However , dose calculations and inconvenient administration may affect compliance and efficacy . We compared the efficacy and safety of a novel fixed-dose ferric carboxymaltose regimen ( FCM ) with individually calculated iron sucrose ( IS ) doses in patients with inflammatory bowel disease ( IBD ) and IDA . METHODS This r and omized , controlled , open-label , multicenter study included 485 patients with IDA ( ferritin < 100 μg/L , hemoglobin [ Hb ] 7 - 12 g/dL [ female ] or 7 - 13 g/dL [ male ] ) and mild-to-moderate or quiescent IBD at 88 hospitals and clinics in 14 countries . Patients received either FCM in a maximum of 3 infusions of 1000 or 500 mg iron , or Ganzoni-calculated IS dosages in up to 11 infusions of 200 mg iron . Primary end point was Hb response ( Hb increase ≥ 2 g/dL ) ; secondary end points included anemia resolution and iron status normalization by week 12 . RESULTS The results of 240  FCM-treated and 235 IS-treated patients were analyzed . More patients with FCM than IS achieved Hb response ( 150 [ 65.8 % ] vs 118 [ 53.6 % ] ; 12.2 % difference , P = .004 ) or Hb normalization ( 166 [ 72.8 % ] vs 136 [ 61.8 % ] ; 11.0 % difference , P = .015 ) . Both treatments improved quality of life scores by week 12 . Study drugs were well tolerated and drug-related adverse events were in line with drug-specific clinical experience . Deviations from scheduled total iron dosages were more frequent in the IS group . CONCLUSIONS The simpler FCM-based dosing regimen showed better efficacy and compliance , as well as a good safety profile , compared with the Ganzoni-calculated IS dose regimen OBJECTIVE : Inflammatory bowel disease (IBD)-associated anemia responds to i.v . iron therapy . However , because of concurrent chronic inflammation , some patients do not respond adequately . Erythropoietin therapy has been shown to be effective in the latter cohort . Our goal was to find parameters that can predict the effectiveness of iron sucrose in IBD-associated anemia . METHODS : One hundred three patients with severe IBD-associated anemia ( Hb ≤ 10.5 g/dl ) were treated prospect ively for 4 wk with iron sucrose ( total iron dose = 1.2 g ) in an open label , multicenter trial . Treatment response was defined as an increase in Hb of ≥2.0 g/dl . A logistic regression analysis was performed with treatment response as the dependent variable and the following independent variables : serum erythropoietin , mean corpuscular Hb , transferrin , ferritin , soluble transferrin receptor ( sTfR ) , C-reactive protein , interleukin 6 ( IL-6 ) , and disease activity . RESULTS : Sixty-seven of 103 patients ( 65 % ) responded to iron sucrose . From the variables under investigation , erythropoietin , sTfR , transferrin , and IL-6 were significantly associated with treatment response . The R2 values showed that erythropoietin ( 8.0 % ) , sTfR ( 11.4 % ) , and transferrin ( 10.4 % ) , but not IL-6 ( 1.3 % ) , contribute a relevant amount of information to the model . An estimated 80 % probability of treatment response was found at erythropoietin levels of > 166 U/L , sTfR levels of > 75 nmol/L , or transferrin levels of > 3.83 g/L. CONCLUSIONS : Serum erythropoietin , sTfR , and transferrin concentrations have the potential to predict the response to iron sucrose therapy in IBD-associated anemia . These parameters may help to identify individuals who benefit the most from additional erythropoietin treatment Abstract Objective . Iron isomaltoside 1000 ( Monofer ® ) is a high-dose intravenous ( IV ) iron , which in a recent 8 weeks trial in inflammatory bowel disease ( IBD ) subjects with iron deficiency anemia ( IDA ) demonstrated good tolerability and efficacy . The present trial is an extension to this trial , which evaluates the need for additional high IV iron doses to maintain a stable hemoglobin ( Hb ) ≥12.0 g/dl . Material and methods . This was a prospect i ve , open-label , 12 months trial of European IBD subjects willing to participate after completing the lead-in trial . Subjects were allowed re-dosing with 500–2000 mg single doses of iron isomaltoside 1000 infused over ∼15 min at 3 months intervals depending on a predefined algorithm . Outcome measures included Hb , safety parameters and need for additional iron dosing . Results . A total of 39 subjects were enrolled of which 34 subjects required re-dosing with a median cumulative 1-year dose of 1.8 g ( mean cumulative dose 2.2 g ) . The mean ( SD ) Hb was 12.3 ( 1.5 ) g/dl at baseline , 12.8 ( 1.6 ) g/dl at 3 months , 12.8 ( 1.6 ) g/dl at 6 months , 12.9 ( 1.4 ) g/dl at 9 months and 12.9 ( 1.6 ) g/dl at 12 months . Seventy-four percent of subjects who had an Hb ≥12.0 g/dl at baseline were able to maintain Hb ≥12.0 g/dl till the end of the trial at 12 months . Nonserious probably related hypersensitivity reactions without significant hypotension were reported at the beginning of the infusion in two subjects , who recovered without sequelae . Conclusion . Repeated treatment of iron deficiency with iron isomaltoside 1000 could avoid episodes of IDA without major safety issues . Trial registration : Clinical Trial.gov identifier : NCT01410435 AIM OF THE STUDY To describe our 15-year experience on the patients ' response and safety to the use of EPO in IBD patients with refractory anemia . PATIENTS - METHODS Single center retrospective chart analysis of all IBD patients receiving EPO for the period 1994 - 2009 . Patients with resistant anemia not responding to I.V. iron therapy were enrolled . Concommitant medication , medical and laboratory data on short and long-term patients ' responses and safety were recorded . RESULTS In total 820 IBD files were review ed and among 78 patients treated with I.V. iron  we identified 26 patients who received EPO in concordance to our inclusion criteria . Azathioprine or methotrexate was administered in 17 patients and 7 patients received concomitant Infliximab . After EPO , 22/26 patients ( 84.6 % ) responded and peripheral blood parameters were significantly improved and blood transfusions were significantly decreased ( p<0.001 ) . Erythropoietin dose was increased in three non-responders while two patients required emergency transfusions . No adverse events were recorded . CONCLUSIONS In anemic IBD patients who are refractory to I.V. iron monotherapy  , administration of EPO significantly improved peripheral blood parameters with safety . Prospect i ve controlled trials are needed to confirm positive patients ' response to EPO and identify those patients who are more likely to benefit OBJECTIVES Anemia is the most common hematological alteration in patients with Crohn 's disease , and is frequently related to intestinal inflammatory activity . Its cause is multifactorial and mostly associated with absolute iron deficiency ( iron deficiency anemia ) and /or functional iron deficiency ( inflammation anemia or anemia of chronic disease ) . It may also be identified through other causes , such as folic acid or vitamin B12 deficiency and secondary to adverse effects from medications ( salicylic derivatives and immunosuppressive drugs ) . In the present study , patients with active Crohn 's disease and anemia were evaluated and treated with intravenous ferric carboxymaltose . We discuss the therapeutic schemes ( doses ) , safety , results and improvement of quality of life . METHODS In the present prospect i ve study , 10 consecutive patients with Crohn 's disease , with moderate to severe activity , with anemia ( Hb : 6.7 to 10 g/dL ) , who were attended between March 2014 and March 2015 , were evaluated . Six ( 60 % ) were men and four were women , all with moderate or severe anemia ( hemoglobin < 10 g/dL ) . They were treated with a maximum of three intravenous infusions of 1000 mg of ferric carboxymaltose , of at least 15 minutes in duration . It was also sought to correlate the inflammatory Crohn 's disease activity degree ( measured using the Crohn 's Disease Activity Index , CDAI ) and C-reactive protein level with the severity of anemia . The primary outcome was an increase in Hb of ≥2 g/dL and the secondary outcome was the normalization of anemia ( Hb ≥12 g/dL for women and ≥13 g/dL for men ) and the improvement in quality of life seen 12 weeks after the last application of carboxymaltose . RESULTS Among the 10 patients studied , parenteral iron supplementation was administered in three cases during hospitalization and the others received this on an outpatient basis . The total iron dose ranged from 1,000 to 2,000 mg , with an average of 1,650 mg . Crohn 's disease activity measured using CDAI and C-reactive protein correlated with the intensity of anemia . An increase of 2 g/dL occurred in eight ( 80 % ) patients after 12 weeks and normalization of anemia was found in seven ( 70 % ) patients . Improvements in quality -of-life scores were found for all ( 100 % ) patients after 12 weeks . Carboxymaltose was well tolerated . Three patients presented adverse reactions ( two with nausea and one with headache ) of mild intensity . CONCLUSIONS Anemia is a frequent complication for Crohn 's disease patients . Intravenous iron therapy has been recommended for Crohn 's disease patients , because for these patients , oral iron absorption is very limited . This is because of the inflammatory state and " blocking " of iron entry into enterocytes through hepcidin action on ferroportin , along with the elevated rates of gastrointestinal adverse events that compromise adherence to treatment and possibly aggravate the intestinal inflammatory state . The degree of Crohn 's disease activity , as measured using CDAI and C-reactive protein , correlates with the severity of anemia .  Carboxymaltose is a safe drug , which can be administrated in high doses ( up to 1,000 mg per application per week ) and corrects anemia and iron stocks over a short period of time , with consequent improvement in quality of life The behavioral effects of iron deficiency and its treatment were evaluated in a double-blind r and omized controlled community-based study of 191 Costa Rican infants , 12 to 23 months of age , with various degrees of iron deficiency . The Bayley Scales of Infant Development were administered before and both 1 week and 3 months after IM or oral administration of iron . Appropriate placebo-treated control infants were also tested . Infants with iron deficiency anemia showed significantly lower mental and motor test scores , even after considering factors relating to birth , nutrition , family background , parental IQ , and the home environment . After 1 week , neither IM nor oral iron treatments differed from placebo treatment in effects on scores . After 3 months , lower mental and motor test scores were no longer observed among iron-deficient anemic infants whose anemia and iron deficiency were both corrected ( 36 % ) . However , significantly lower mental and motor test scores persisted among the majority of initially anemic infants ( 64 % ) who had more severe or chronic iron deficiency . Although no longer anemic , they still showed biochemical evidence of iron deficiency after 3 months of treatment . These persistent lower scores suggest either that iron therapy adequate for correcting anemia is insufficient to reverse behavioral and developmental disturbances in many infants or that certain ill effects are long-lasting , depending on the timing , severity , or chronicity of iron deficiency anemia in infancy The aim of this study was to prospect ively determine the etiology of anemia in a cohort of community-dwelling older out patients with a comprehensive hematologic evaluation . Participants were men and women age 65 and older with anemia as defined by World Health Organization criteria recruited from outpatient hematology clinics at Stanford Hospital and Clinics ( SHC ) and Veterans Affairs Palo Alto Health Care System ( VAPAHCS ) . Each participant underwent a history and physical examination , followed by a comprehensive hematologic evaluation  , which in all participants included  complete blood count , red cell indices , review of the blood smear ,  and  assessment of vitamin B12 , folate , iron status and renal function .  Additional evaluation was obtained by clinical providers as per their discretion . 190 participants enrolled and completed the evaluation . Twelve percent of participants had iron deficiency anemia . Of those with iron deficiency in whom there was follow-up information , half normalized their hemoglobin in response to iron repletion , and half did not . Thirty-five percent of participants had unexplained anemia . Those with unexplained anemia had mildly increased inflammatory markers compared to non-anemic controls , and , at the lower hemoglobin ranges had relatively low erythropoietin levels . Sixteen percent of participants were categorized as being " suspicious for myelodysplastic syndrome . " Thus , even with comprehensive hematologic evaluation , unexplained anemia is common in older anemic out patients . Iron deficiency anemia is also common and can be difficult to diagnose , and frequently the anemia is not fully corrected with iron repletion In a double-blind , placebo-control prospect i ve cohort study of 196 infants from birth to 15 months of age , assessment was made at 12 months of age of the relationship between iron status and psychomotor development , the effect of a short-term ( 10-day ) trial of oral iron vs placebo , and the effect of long-term ( 3 months ) oral iron therapy . Development was assessed with the mental and psychomotor indices and the infant behavior record of the Bayley Scales of Infant Development in 39 anemic , 30 control , and 127 nonanemic iron-deficient children . Anemic infants had significantly lower Mental and Psychomotor Developmental Index scores than control infants or nonanemic iron-deficient infants ( one-way analysis of variance , P less than .0001 ) . Control infants and nonanemic iron-deficient infants performed comparably . No difference was noted between the effect of oral administration of iron or placebo after 10 days or after 3 months of iron therapy . Among anemic infants a hemoglobin concentration less than 10.5 g/dL and duration of anemia of greater than 3 months were correlated with significantly lower motor and mental scores ( P less than .05 ) . Anemic infants failed specifically in language capabilities and body balance-coordination skills when compared with controls . These results , in a design in which intervening variables were closely controlled , suggest that when iron deficiency progresses to anemia , but not before , adverse influences in the performance of developmental tests appear and persist for at least 3 months despite correction of anemia with iron therapy . If these impairments prove to be long st and ing , prevention of iron deficiency anemia in early infancy becomes the only way to avoid them PURPOSE Elderly patients are vulnerable to the dose-dependent adverse effects of iron replacement therapy . Our study examines whether low-dose iron therapy can efficiently resolve iron-deficiency anemia in patients over the age of 80 years and reduce adverse effects . SUBJECTS AND METHODS Ninety hospitalized patients with iron-deficiency anemia were r and omized to receive elemental iron in daily doses of 15 mg or 50 mg as liquid ferrous gluconate or 150 mg of ferrous calcium citrate tablets for 60 days . Thirty control patients without anemia were given 15 mg of iron for 60 days . A 2-hour iron absorption test was performed after the initial dose . Hemoglobin and ferritin levels were measured on day 1 , 30 , and 60 after initiating therapy . Each patient completed a weekly question naire regarding drug-induced adverse effects . RESULTS Serum iron rose significantly in the anemic patients beginning 15 minutes after the first dose but not in nonanemic patients . Two months of iron treatment significantly increased hemoglobin and ferritin concentrations similarly in all 3 groups of iron-deficiency anemia patients ( for example , hemoglobin levels rose from 10.0 g/dL to 11.3 g/dL with 15 mg/d of iron therapy and from 10.2 g/dL to 11.6 g/dL with 150 mg/d ) . Abdominal discomfort , nausea , vomiting , changes in bowel movements , and black stools were significantly more common at higher iron doses . CONCLUSIONS Low-dose iron treatment is effective in elderly patients with iron-deficiency anemia . It can replace the commonly used higher doses and can significantly reduce adverse effects Background and Aims The U.S. population is aging and the burden of geriatric inflammatory bowel disease ( IBD ) patients has increased . Systematic data describing phenotypic presentation , treatment regimens , outcomes and comorbidities in elderly IBD patients is limited . We performed a retrospective observational study of IBD patients age ≥65 followed in a 20-hospital system to determine patterns of phenotypic presentation , treatment , polypharmacy , nutritional status and comorbidity . Methods Data were extracted from electronic medical record based on ICD-9 coding/indexed terms on Crohn ’s disease ( CD ) and ulcerative colitis ( UC ) patients . Results A total of 393 geriatric IBD patients were identified ( 49.1 % males ; 50.9 % females ; 61.8 % UC ; 38.2 % CD ; 73.4 ± 6.6 years old ) . Younger age at diagnosis of CD ( ≤64 ) was associated with greater prevalence of small bowel surgeries ( 63.6 % ) compared with those diagnosed after age ≥65 ( 20.9 % ) ( p < 0.005 ) . Fistulizing/penetrating disease was frequent in patients diagnosed with CD at a younger age ( 43.6 % compared to 7 % ) ( p < 0.005 ) . IBD maintenance treatment included : 44 % 5-ASA agents ; 31.6 % maintenance prednisone ( defined as ≥6 months treatment duration ) ; 4.8 % steroid suppositories ; 5.6 % 6MP/azathioprine ; 1.3 % methotrexate ; 1.3 % adalimumab ; 1.3 % infliximab ; 9.4 % loperamide/diphenoxylate/atropine ; 0.5 % had no IBD medications . Longer duration of CD disease correlated with vitamin B12 , vitamin D and iron deficiency . Conclusion Geriatric patients diagnosed with CD earlier in life  had greater small bowel involvement compared with new onset geriatric CD . There is low utilization of immunomodulator and biologic agents in geriatric IBD patients  . Duration of CD correlates with nutrient deficiency . Prospect i ve studies are warranted in this respect BACKGROUND Evidence suggests that brain iron deficiency at any time in life may disrupt metabolic processes and subsequently change cognitive and behavioral functioning . Women of reproductive age are among those most vulnerable to iron deficiency and may be at high risk for cognitive alterations due to iron deficiency . OBJECTIVE We aim ed to examine the relation between iron status and cognitive abilities in young women . DESIGN A blinded , placebo-controlled , stratified intervention study was conducted in women aged 18 - 35 y of varied iron status who were r and omly assigned to receive iron supplements or a placebo .  Cognition was assessed by using 8  cognitive performance tasks  ( from Detterman 's Cognitive Abilities Test ) at baseline ( n = 149 ) and after 16 wk of treatment ( n = 113 ) . RESULTS At baseline , the iron-sufficient women ( n = 42 ) performed better on cognitive tasks ( P = 0.011 ) and completed them faster ( P = 0.038 ) than did the women with iron deficiency anemia ( n = 34 ) . Factors representing performance accuracy and the time needed to complete the tasks by the iron-deficient but nonanemic women ( n = 73 ) were intermediate between the 2 extremes of iron status . After treatment , a significant improvement in serum ferritin was associated with a 5 - 7-fold improvement in cognitive performance , whereas a significant improvement in hemoglobin was related to improved speed in completing the cognitive tasks . CONCLUSIONS Iron status is a significant factor in cognitive performance in women of reproductive age . Severity of anemia primarily affects processing speed , and severity of iron deficiency affects accuracy of cognitive function over a broad range of tasks . Thus , the effects of iron deficiency on cognition are not limited to the developing brain BACKGROUND AND AIMS Infliximab ( IFX ) and iron sucrose ( FeS ) are of high value in inflammatory bowel disease ( IBD ) . We aim ed to assess the relative role of both therapies in IBD related anaemia and their safety when used in combination . METHODS IBD patients with anaemia receiving a first series of FeS infusions in addition to IFX were prospect ively followed . We investigated serum kinetics of erythropoietin ( EPO ) , soluble transferrin receptors ( sTFRs ) and vascular endothelial growth factor ( VEGF ) . RESULTS Data analysis included 87 patients of whom 49.4 % achieved the target Hb level of 12.0 g/dL.  IFX result ed in a significant increase of EPO and sTFR compared to baseline pre-IFX levels ( p=0.029 and p=0.005 respectively ) and after a 12-week combined FeS and IFX treatment , EPO and sTFR levels dropped significantly compared to pre-FeS levels ( p<0.001 for both ) . Infusion related adverse events were recorded in 2 IFX treated patients ( 2.3 % , 0.7 % of the infusions ) and were mild . Disease activity and quality of life were not affected . CONCLUSIONS In anaemic IBD patients treated with IFX  , combined administration of FeS is safe . Infliximab significantly increases serum EPO and sTFR levels result ing in an increased functional iron deficiency , which is restored after combined treatment with I.V. iron sucrose Background : Secondary thrombocytosis is a common clinical feature . In patients with cancer , it is a risk factor for venous thromboembolic events . In inflammatory bowel disease ( IBD ) , thrombocytosis is so far considered a marker of active disease and may contribute to the increased thromboembolic risk in this population . Observed effects of iron therapy on normalization of platelet counts led us to hypothesize that iron itself may regulate megakaryopoiesis . Here , we want to test the effect of iron replacement on platelet count and activity in IBD-associated thrombocytosis . Methods : We performed a r and omized , single-blinded placebo-controlled trial testing the effect of ferric carboxymaltose ( FCM ) in patients with IBD with secondary thrombocytosis ( platelets > 450 G/L ) . Changes in platelet counts , hemoglobin , iron parameters , disease activity , megakaryopoietic growth factors , erythropoietin , and platelet activity were assessed . Patients received placebo or up to 1500 mg iron as FCM . Endpoints were evaluated at week 6 . Results : A total of 26 patients were included in the study , 15 patients were available for the per protocol analysis . A drop in platelets > 25 % ( primary endpoint ) was observed in 4 of 8 ( 50 % , iron group ) and 1 of 7 patients ( 14 % , placebo group , P = 0.143 ) . Mean platelet counts dropped on FCM but not on placebo ( 536 G/L to 411 G/L versus 580 G/L to 559 G/L ; P = 0.002 ) . Disease activity and megakaryopoietic growth factors remained unchanged and hemoglobin and iron parameters increased on FCM . The normalization of platelet counts was associated with a decrease in platelet aggregation and P-selectin expression . Conclusion : FCM lowers platelet counts and platelet activation in patients with IBD-associated secondary thrombocytosis 39 pregnant women , hemoglobin in serum less than or equal to 6,80 mmol/l were treated with Vitaferro , Folicombin and additional vitamins . Test groups were formed by means of r and omisation . Hematological and clinicochemical parameters were measured before , as well as 2 and 6 weeks after starting treatment and the results were evaluated .-- In the diagnosis of iron deficiency anemia in pregnancy serum iron concentration and iron-binding capacity are sufficient . The diagnosis is proved by an increase of the serum hemoglobin 2 weeks after starting therapy . For the total number of patients an increase of hemoglobin could be proved 2- and 6 weeks after starting therapy . However , the 3 chosen therapeutic methods did not show any differences in statistically proved values in form of therapeutic results . This is , in our view , due to given deviation and the specific character of the test group . During pregnancy iron deficiency anemia should be treated by doses more than 100 mg iron per day . Normalization of the hemoglobin under iron substitution is no indication for immediate interruption of the treatment OBJECTIVE To evaluate the impact that a program based on maternal dietary counseling covering breastfeeding and healthy complementary feeding had on the prevalence of  iron deficiency , anemia and iron deficiency anemia in children aged 12 to 16 months . METHODS Newborn infants were r and omized at birth to an intervention or a control group . Mothers in the intervention group received home visits during the children 's first year of life on a monthly basis up to 6 months , and at 8 , 10 and 12 months . The mothers in the control group received visits for data collection when children reached 6 and 12 months . All children were visited at ages between 12 and 16 months and 24-hour dietary recalls and hemoglobin and ferritin tests were conducted . RESULTS There was no evidence that the intervention had an effect on anemia incidence , which was 66.5 % in the intervention group and 61.8 % in the control group . There was also no evidence of any difference between the groups in the prevalence of iron deficiency anemia or of iron deficiency . However , a higher percentage of children in the intervention group were exclusively breastfed at 4 and 6 months , and breastfed at 6 and 12 months . Intervention group children also consumed more meat and were fed diets with better iron bioavailability and consumed less cow 's milk and calcium than children from the control group . CONCLUSION This intervention had no effect on the prevalence of anemia , iron deficiency or iron deficiency anemia . Clinical trial registry identification number : NCT00629629
However , in patients with IBD flares and inadequate responses to or side effects with oral preparations , intravenous iron supplementation is the therapy of choice .
Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD , and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics .
Based on the data presented , oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency  anemia unless such patients are intolerant or have an inadequate response , whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron
Abstract Anemia is the most frequent complication of inflammatory bowel disease ( IBD ) , but anemia , mostly due to iron deficiency , has long been neglected in these patients .
The aim was to briefly present the pathophysiology , followed by a balanced overview of the different forms of iron replacement available , and subsequently , to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD .