Published online 8 October 2009
Haematologica, Vol 95, Issue 2, 199-205 doi:10.3324/haematol.2009.009985
Copyright © 2010 by Ferrata Storti Foundation
Prevalence and pathogenesis of anemia in inflammatory bowel disease. Influence of anti-tumor necrosis factor-
Gaetano Bergamaschi1 ,
Antonio Di Sabatino1 ,
Riccardo Albertini2 ,
Sandro Ardizzone3 ,
Paolo Biancheri1 ,
Elisa Bonetti4 ,
Andrea Cassinotti3 ,
Paolo Cazzola1 ,
Konstantinos Markopoulos1 ,
Alessandro Massari3 ,
Vittorio Rosti5 ,
Gabriele Bianchi Porro3 ,
Gino R. Corazza1
Haematologica, Vol 95, Issue 2, 199-205 doi:10.3324/haematol.2009.009985
Copyright © 2010 by Ferrata Storti Foundation
Anemia of Chronic Disease |
Prevalence and pathogenesis of anemia in inflammatory bowel disease. Influence of anti-tumor necrosis factor-
treatment
1 Department of Internal Medicine, University of Pavia Medical School and Fondazione IRCCS Policlinico San Matteo, Pavia
2 Clinical Chemistry Laboratory, Fondazione IRCCS Policlinico San Matteo, Pavia
3 Division of Gastroenterology, "L. Sacco" University Hospital, Milan
4 Laboratory of Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia
5 Laboratory of Organ Transplantation, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Correspondence: Gaetano Bergamaschi, Clinica, Medica I, Policlinico San Matteo, Piazzale Golgi, 27100 Pavia, Italy. E-mail: n.bergamaschi{at}smatteo.pv.it
Background: Anemia is a common complication of inflammatory bowel disease, but its epidemiology may be changing due to earlier diagnosis and improved treatments. We investigated the prevalence and pathogenesis of anemia in patients with inflammatory bowel disease.
Design and Methods: In a cross-sectional study 263 out-patients with inflammatory bowel disease (165 with Crohn’s disease, 98 with ulcerative colitis) were investigated. The influence of time from diagnosis, disease activity, inflammation and the status of iron and hematinic vitamins on the level of hemoglobin and prevalence of anemia were evaluated. In a second group of 27 patients with Crohn’s disease, undergoing anti-tumor necrosis factor-
treatment with infliximab because of refractory or fistulizing disease, we determined the effects of infliximab on disease activity, hemoglobin, serum erythropoietin levels, iron status and inflammation.
Results: In all, 104 of the 263 patients with inflammatory bowel disease were anemic. Age, gender and azathioprine treatment had no influence on anemia. The prevalence of anemia was highest at diagnosis (65%), decreased during the first 4 years after disease onset, and was stable thereafter. Active disease was associated with higher rates of anemia. At diagnosis most anemic patients had anemia of chronic disease; during follow-up iron deficiency and multifactorial forms of anemia became more prevalent. Eighteen of 27 patients undergoing treatment with infliximab were anemic; most of them had anemia of chronic disease. Infliximab reduced disease activity and improved anemia in 12 patients. This was mediated by an increased production of erythropoietin for the degree of anemia. In vitro infliximab increased the growth of erythroid progenitors from the peripheral blood of patients with active disease.
Conclusions: Anemia is a common problem in out-patients with inflammatory bowel disease; the prevalence and severity of anemia are related to the activity of the bowel disorder. The pathogenesis of anemia changes during the course of the disease, with anemia of chronic disease having a major role at diagnosis and iron deficiency and multifactorial forms of anemia during follow-up. In patients requiring anti-tumor necrosis factor- treatment, response to therapy improves erythropoiesis.
Key words: anemia, inflammatory bowel, iron deficiency.
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