Anemia in children with inflammatory bowel diseases

Česká verze

Authors: E. Karásková ¹; D. Pospíšilová ¹; M. Horváthová ²; M. Velgáňová-Véghová ¹; M. Špenerová ¹; M. Geryk ¹; J. Volejníková ¹
Authors place of work: Dětská klinika, FN a LF Univerzity Palackého, Olomouc ¹; Ústav biologie FN a LF Univerzity Palackého, Olomouc ²
Published in the journal: Čes-slov Pediat 2020; 75 (5): 278-283.
Category: Přehledový článek

Summary

Anemia is the most common extraintestinal complication of inflammatory bowel disease. Iron deficiency anemia and anemia of chronic disease are the most frequent types. Iron deficiency and chronic inflammation are often combined in patients with inflammatory bowel diseases: total iron body stores are sufficient, but are not available for erytropoiesis (so called “functional” iron deficiency). Hepcidin (interaction of hepcidin-ferroportin) is a key regulator of iron metabolism and also marker of systemic inflammation. Hepcidin binds to ferroportin and blocks its function.

The diagnosis and treatment of anemia are guided by available recommendations and the current serum level of hepcidin, in addition to other markers, may contribute to the decision of adequate form of iron supplementation (parenteral versus oral).

Keywords:

anemia – inflammatory bowel disease – hepcidin – ferroportin

Zdroje

1. Kolek A, Janout V, Tichý M, et al. The incidence of inflammatory bowel disease is increasing among children 15 years old and younger in the Czech Republic. J Pediatr Gastroenterol Nutr 2004 Mar; 38 (3): 362–363.

2. Schwarz J, Sýkora J, Cvalínová D, et al. Inflammatory bowel disease incidence in Czech children: A regional prospective study, 2000–2015. World J Gastroenterol 2017 Jun 14; 23 (22): 4090–4101.

3. Bousvaros A. Use of immunomodulators and biologic therapies in children with inflammatory bowel disease. Expert Rev Clin Immunol 2010; 6: 659–666.

4. Patel D, Trivedi C, Khan N. Management of anemia in patients with inflammatory bowel disease (IBD). Curr Treat Options Gastroenterol 2018 Mar; 16 (1): 112–128.

5. Wiskin AE, Fleming BJ, Wootton SA, et al. Anaemia and iron deficiency in children with inflammatory bowel disease. J Crohns Colitis 2012; 6: 687–691.

6. Wells CW, Lewis S, Barton JR, et al. Effects of changes in haemoglobin level on quality of life and cognitive function in inflammatory bowel disease patients. Inflamm Bowel Dis 2006; 12: 123–130.

7. Dignass AU, Gasche C, Bettenworth D, et al. European Crohn’s and Colitis Organisation [ECCO]. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis 2015; 9: 211–222.

8. Park CH, Valore EV, Waring AJ, et al. Hepcidin, a urinary antimicrobial peptide synthesized in the liver. J Biol Chem 2001 Mar 16; 276 (11): 7806–7810.

9. Casu C, Nemeth E, Rivella S. Hepcidin agonists as therapeutic tools. Blood 2018 Apr 19; 131 (16): 1790–1794.

10. Krawiec P, Mroczkowska-Juchkiewicz A, Pac-Kożuchowska E. Serum hepcidin in children with inflammatory bowel disease. Inflamm Bowel Dis 2017; 23: 2165–2171.

11. Ganz T. Hepcidin and iron regulation, 10 years later. Blood 2011 Apr 28; 117 (17): 4425–4433.

12. Dignass A, Farrag K, Stein J. Limitations of serum ferritin in diagnosing iron deficiency in inflammatory conditions. Int J Chronic Dis 2018 Mar 18; 2018: 9394060.

13. Bergamaschi G, Di Sabatino A, Albertini R, et al. Serum hepcidin in inflammatory bowel diseases: biological and clinical significance. Inflamm Bowel Dis 2013; 19: 2166–2172.

14. Khan N, Patel D, Shah Y, et al. Factors predicting testing and treatment of iron deficiency in a nationwide cohort of anemic UC patients. Inflamm Bowel Dis 2016 Dec; 22 (12): 2894–2901.

15. Auerbach M, Adamson JW. How we diagnose and treat iron deficiency anemia. Am J Hematol 2016 Jan; 91 (1): 31–38.

16. Borel MJ, Smith SM, Derr J, et al. Day-to-day variation in iron-status indices in healthy men and women. Am J Clin Nutr 1991 Oct; 54 (4): 729–735.

17. Ford BA, Coyne DW, Eby CS, et al. Variability of ferritin measurements in chronic kidney disease; implications for iron management. Kidney Int 2009 Jan; 75 (1): 104–110.

18. Kaitha S, Bashir M, Ali T. Iron deficiency anemia in inflammatory bowel disease. World J Gastrointest Pathophysiol 2015; 6: 62–72.

19. Infusino I, Braga F, Dolci A, et al. Soluble transferrin receptor (sTfR) and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia. A meta-analysis. Am J Clin Pathol 2012 Nov; 138 (5): 642–649.

20. Camaschella C. New insights into iron deficiency and iron deficiency anemia. Blood Rev 2017 Jul; 31 (4): 225–233.

21. van der Vorm LN, Hendriks JC, Laarakkers CM, et al. Toward worldwide hepcidin assay harmonization: Identification of a commutable secondary reference material. Clin Chem 2016; 62: 993–1001.

22. Wolff F, Deleers M, Melot C, et al. Hepcidin-25: Measurement by LC-MS/MS in serum and urine, reference ranges and urinary fractional excretion. Clin Chim Acta 2013; 423: 99–104.

23. Galesloot TE, Vermeulen SH, Geurts-Moespot AJ, et al. Serum hepcidin: reference ranges and biochemical correlates in the general population. Blood 2011; 117: e218–225.

24. Sdogou T, Tsentidis C, Gourgiotis D, et al. Immunoassay-based serum hepcidin reference range measurements in healthy children: differences among age groups. J Clin Lab Anal 2015; 29: 10–14.

25. Uijterschout L, Swinkels DW, Domellöf M, et al. Serum hepcidin measured by immunochemical and mass-spectrometric methods and their correlation with iron status indicators in healthy children aged 0.5–3 y. Pediatr Res 2014; 76: 409–414.

26. Cangemi G, Pistorio A, Miano M, et al. Diagnostic potential of hepcidin testing in pediatrics. Eur J Haematol 2013; 90: 323–330.

27. Reifen R, Matas Z, Zeidel L, et al. Iron supplementation may aggravate inflammatory status of colitis in a rat model. Dig Dis Sci 2000 Feb; 45 (2): 394–397.

28. Carrier J, Aghdassi E, Platt I, et al. Effect of oral iron supplementation on oxidative stress and colonic inflammation in rats with induced colitis. Aliment Pharmacol Ther 2001 Dec; 15 (12): 1989–1999.

29. Zimmermann MB, Chassard C, Rohner F, et al. The effects of iron fortification on the gut microbiota in African children: a randomized controlled trial in Cote d‘Ivoire. Am J Clin Nutr 2010 Dec; 92 (6): 1406–1415.

30. Lee T, Clavel T, Smirnov K, et al. Oral versus intravenous iron replacement therapy distinctly alters the gut microbiota and metabolome in patients with IBD. Gut 2017 May; 66 (5): 863–871.

31. Schröder O, Mickisch O, Seidler U, et al. 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. Am J Gastroenterol 2005 Nov; 100 (11): 2503–2509.

32. Lee TW, Kolber MR, Fedorak RN, et al. Iron replacement therapy in inflammatory bowel disease patients with iron deficiency anemia: a systematic review and meta-analysis. J Crohns Colitis 2012 Apr; 6 (3): 267–275.

33. Bonovas S, Fiorino G, Allocca M, et al. Intravenous versus oral iron for the treatment of anemia in inflammatory bowel disease: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2016 Jan; 95 (2): e2308.

34. Laass MW, Straub S, Chainey S, et al. Effectiveness and safety of ferric carboxymaltose treatment in children and adolescents with inflammatory bowel disease and other gastrointestinal diseases. BMC Gastroenterol 2014 Oct 17; 14: 184.

35. Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood 2015 Oct 22; 126 (17): 1981–1989.

36. Schaap CC, Hendriks JC, Kortman GA, et al. Diurnal rhythm rather than dietary iron mediates daily hepcidin variations. Clin Chem 2013 Mar; 59 (3): 527–535.

37. Bregman DB, Morris D, Koch TA, et al. Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia. Am J Hematol 2013 Feb; 88 (2): 97–101.

38. Karaskova E, Volejnikova J, Holub D, et al. Hepcidin in newly diagnosed inflammatory bowel disease in children. J Paediatr Child Health 2018 Jun 20. doi: 10.1111/jpc.14093.