Çocukluk Çağı İnflamatuar Bağırsak Hastalıklarında Aneminin Sıklığı, Türleri ve Risk Faktörleri

Year 2024, Volume: 7 Issue: 3, 301 - 307, 27.10.2024

Nihal Uyar Aksu , Emine Zengin , Ayşen Uncuoğlu

https://doi.org/10.53446/actamednicomedia.1479014

Abstract

Amaç: İnflamatuvar bağırsak hastalığı olan hastalar tanı ve takip sırasında anemik olmaya eğilimlidir. Anemi, yaygın bir ekstra-intestinal bulgu olduğundan, erken tanınması ve tedavisi önemlidir. Bu çalışmada pediatrik inflamatuar bağırsak hastalığı olan hastalarda aneminin sıklığını, tipini, risk faktörlerini ve tedavisini değerlendirmeyi amaçladık.
Yöntem: 1 Nisan 2018 ile 01 Mayıs 2019 tarihleri arasında polikliniğimize başvuran pediatrik İBH hastalarının elektronik kayıtları retrospektif olarak değerlendirildi. Hemoglobin, hematokrit, ortalama korpüsküler hacim, demirle ilgili belirteçler, B12 vitamini düzeyi, folik asit düzeyi, retikülosit sayısı, C-reaktif protein ve eritrosit sedimentasyon hızı sonuçlarına aynı gün içerisinde en az bir kez bakılmış olan hastalar çalışmaya dahil edildi. Üç ve altı aylık takiplerde anemi ile ilişkili laboratuvar sonuçları ve hastalık aktivite indeksi skorları kaydedildi. Çocukluk çağında anemi tanısı WHO kriterlerine göre konuldu. Anemi, risk faktörleri ve anemi tedavisi belirlendi.
Bulgular: Kırk hasta çalışmaya dahil edildi. İlk değerlendirmede Crohn hastalarının %38,1'inde, ülseratif kolit hastalarının ise %57,9'unda anemi gözlendi. Her iki grupta da ana anemi tipi demir eksikliği anemisiydi. Takiplerde anemi oranının azaldığı görüldü. Kırk hastadan 21'i ilk değerlendirmede tedavi aldı. Aktif hastalığa sahip olma demir eksikliği anemisinin tek risk faktörüydü.
Sonuç: Pediatrik inflamatuvar bağırsak hastalığı olan hastalarda anemi, 6 aylık takipte %25-47,5 arasında değişmekte olup, sık görülmektedir. Demir eksikliği anemisi aneminin ana tipiydi. Aktif hastalığa sahip olmak anemi için tek risk faktörüydü. Anti-inflamatuvar tedaviye paralel olarak anemi ve anemi olmaksızın demir eksikliğinin tedavisi de çocukluk çağı inflamatuvar bağırsak hastalığında akılda tutulmalıdır.

Keywords

Anemi, inflamatuvar barsak hastalığı, çocuklar, demir eksikliği

Frequency, Types, and Risk Factors of Anemia in Pediatric Inflammatory Bowel Disease

Abstract

Objective: Inflammatory bowel disease patients are prone to be anemic at diagnosis and follow-up. As it is a common extra-intestinal manifestation, its early identification and treatment are essential. We aimed to evaluate the frequency, types, and predictors of anemia and its treatment in pediatric inflammatory bowel disease patients.
Methods: The electronic records of pediatric IBD patients who attended our outpatient clinics between 1 April 2018 and 01 May 2019 were retrospectively evaluated. Patients who had the results of hemoglobin, hematocrit, mean corpuscular volume, iron indices, vitamin B12 level, folic acid level, reticulocyte count, C-reactive protein, and erythrocyte sedimentation rate at least once on a single day were included in the study. Laboratory results associated with anemia and disease activity index scores at three- and six-months follow-ups were recorded. Anemia was diagnosed according to WHO criteria in childhood. Anemia, risk factors, and management of anemia were determined.
Results: Forty patients were included in the study. At first evaluation, anemia was observed in 38.1% of Crohn’s disease patients and 57.9% of ulcerative colitis patients. Iron deficiency anemia was the main type of anemia in both groups. The rate of anemia decreased at follow-up. Out of 40 patients, 21 had treatment at the initial evaluation. Active disease was the only predictor of iron deficiency anemia.
Conclusion: Anemia was common in pediatric inflammatory bowel disease patients, ranging between 25-47.5% during the 6-month follow-up in our study. Iron deficiency anemia was the main type of anemia. Having active disease was the only risk factor for anemia. The treatment of anemia and iron deficiency without anemia should be kept in mind in parallel with anti-inflammatory treatment.

Keywords

Anemia, inflammatory bowel disease, children, iron deficiency

References

• Kulnigg S, Gasche C. Systematic review: managing anemia in Crohn’s disease. Aliment Pharmacol Ther. 2006;24:1507-1523. doi:10.1111/j.1365-2036.2006.03146.x
• Wilson A, Reyes E, Ofman J. Prevalence and outcomes of anemia in inflammatory bowel disease: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):44-9s. doi:10.1016/j.amjmed.2003.12.011
• Van Limbergen J, Russel RK, Drummond HE, et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008;135:1114-1122. doi:10.1053/j.gastro.2008.06.081
• Gupta N, Cohen SA, Bostrom AG, et al. Risk factors for initial surgery in pediatric patients with Crohn's disease. Gastroenterology. 2006;130(4):1069-1077. doi:10.1053/j.gastro.2006.02.003
• Gasche C, Berstad A, Befrits R, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13:1545-1553. doi:10.1002/ibd.20285
• Tsiolakidou G, Koutroubakis IE. Stimulating erythropoiesis in inflammatory bowel disease anemia. World J Gastroenterol. 2007;13:4798-4806. doi:10.3748/wjg.v13.i36.4798
• Wilkholm E, Malmborg P, Forssberg M, Hederos CA, Wikström S. Iron deficiency is common during remission in children with Inflammatory bowel disease. Global Pediatric Health. 2016;4:2333794X16633672. doi:10.1177/2333794X16633672
• Niepel D, Klag T, Malek NP, Wehkamp J. Practical guidance for the management of iron deficiency in patients with inflammatory bowel disease. Therap Adv Gastroenterol. 2018;11:1756284818769074. doi:10.1177/1756284818769074
• Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. World Health Organization; Geneva, Switzerland: 2011. pp. 1–6. https://apps.who.int/iris/handle/10665/85839 [accessed 30 December 2022].
• 1Dignass AU, Gasche C, Bettenworth D, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015;9:211-212. doi:10.1093/ecco-jcc/jju009
• 1Ganzoni AM. Intravenous iron-dextran: therapeutic and experimental possibilities. Schweiz Med Wochenschr. 1970;100:301-303.
• Lanzkowsky P. Iron deficiency anemia. In: Lanzkowsky P, Lipton JM, Fish JD eds. Lanzkowsky’s Manual of Pediatric Hematology and Oncology. London: Elsevier; 2016:69-83.
• Aljomah G, Baker SS, Schmidt K, et al. Anemia in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2018;67:351-355. doi:10.1097/MPG.0000000000002002
• Sjöberg D, Holmström T, Larsson M, Nielsen AL, Holmquist L, Rönnblom A. Anemia in a population-based IBD cohort (ICURE): still high prevalence after 1 year, especially among pediatric patients. Inflamm Bowel Dis. 2014;20:2266-2270. doi:10.1097/MIB.0000000000000191
• Wiskin AE, Fleming BJ, Wootton SA, Beattie RM. Anemia and iron deficiency in children with inflammatory bowel disease. J Crohns Colitis. 2012;6:687-691. doi:10.1016/j.crohns.2011.12.001
• Gerasimidis K, Barclay A, Papangelou A, et al. The epidemiology of anemia in pediatric inflammatory bowel disease: prevalence and associated factors at diagnosis and follow-up and the impact of exclusive enteral nutrition. Inflamm Bowel Dis. 2013;19:2411-2422. doi:10.1097/MIB.0b013e31829ed855
• de Laffolie J, Laass MW, Scholz D, Zimmer KP, Buderus S; CEDATA-GPGE Study Group. Prevalence of anemia in pediatric IBD patients and impact on disease severity: Results of the Pediatric IBD-Registry CEDATA-GPGE®. Gastroenterol Res Pract. 2017;2017:8424628. doi:10.1155/2017/8424628
• Goodhand JR, Kamperidis N, Rao A, et al. Prevalence and management of anemia in children, adolescents, and adults with inflammatory bowel disease. Inflamm Bowel Dis. 2012;18:513-19. doi:10.1002/ibd.21740
• Gisbert JP, Bermejo F, Pajares R, et al. Oral and intravenous iron treatment in inflammatory bowel disease: hematological response and quality of life improvement. Inflamm Bowel Dis. 2009;15:1485-91. doi:10.1002/ibd.20925