Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
University of Pavia, Pavia, Italy.
Br J Haematol. 2018 Aug;182(3):319-329. doi: 10.1111/bjh.15254. Epub 2018 May 6.
Immune-mediated disorders affecting the gastrointestinal (GI) tract may compromise GI integrity, interfere with the absorption of nutrients and cause bleeding and inflammation. All these features contribute to the pathogenesis of anaemia, the most prevalent extra-intestinal manifestation of immune-mediated GI disorders. Anaemia is most commonly due to iron deficiency and/or inflammation, but vitamin deficiencies and, more infrequently, autoimmune haemolysis or drug-induced myelosuppression can be involved. Here we address several issues related to the differential diagnosis and treatment of anaemia in immune-mediated GI disorders, giving particular relevance to the problem of iron deficiency anaemia associated with inflammation. It is emphasized how, in most cases, anaemias due to iron or vitamin deficiencies are best treated by parenteral administration of the deficient factor(s), and how the available high dose intravenous (IV) iron formulations can reduce ambulatory and social costs of IV iron supplementation, while improving patient's compliance to treatment. Actual and future treatment possibilities for anaemia of inflammation, involving the use of erythropoiesis stimulating agents, biologicals and hepcidin inhibitors are discussed.
影响胃肠道 (GI) 的免疫介导性疾病可能会损害 GI 的完整性，干扰营养物质的吸收，并导致出血和炎症。所有这些特征都有助于贫血的发病机制，这是免疫介导性 GI 疾病最常见的肠外表现。贫血最常见的原因是缺铁和/或炎症，但维生素缺乏症，以及更罕见的自身免疫性溶血性贫血或药物诱导的骨髓抑制也可能涉及。在这里，我们讨论了与免疫介导性 GI 疾病相关的贫血鉴别诊断和治疗的几个问题，特别强调了与炎症相关的缺铁性贫血问题。我们强调了在大多数情况下，由于缺铁或维生素缺乏引起的贫血最好通过静脉注射（IV）给予缺乏的因子来治疗，以及现有的高剂量 IV 铁制剂如何降低 IV 铁补充的门诊和社会成本，同时提高患者对治疗的依从性。还讨论了炎症性贫血的实际和未来治疗可能性，包括使用促红细胞生成素刺激剂、生物制剂和铁调素抑制剂。
