UMKC School of Medicine, Children's Mercy Kansas City, Kansas City, MO.
Stanford University School of Medicine and the Lucile Packard Children's Hospital, Palo Alto, CA.
J Pediatr Gastroenterol Nutr. 2020 Oct;71(4):563-582. doi: 10.1097/MPG.0000000000002885.
Anemia is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). It can be asymptomatic or associated with nonspecific symptoms, such as irritability, headaches, fatigue, dizziness, and anorexia. In IBD patients, the etiology of anemia is often multifactorial. Various causes include iron deficiency, anemia of inflammation and chronic disease, vitamin deficiencies, hemolysis, or myelosuppressive effect of drugs. Anemia and iron deficiency in these patients may be underestimated because of their insidious onset, lack of standardized screening practices, and possibly underappreciation that treatment of anemia is also required when treating IBD. Practitioners may hesitate to use oral preparations because of their intolerance whereas intravenous preparations are underutilized because of fear of adverse events, availability, and cost. Several publications in recent years have documented the safety and comparative efficacy of various intravenous preparations. This article reviews management of anemia in children with IBD, including diagnosis, etiopathogenesis, evaluation of a patient, protocol to screen and monitor patients for early detection and response to therapy, treatment including parenteral iron therapy, and newer approaches in management of anemia of chronic disease. This report has been compiled by a group of pediatric gastroenterologists serving on the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) IBD committee, in collaboration with a pediatric hematologist, pharmacist, and a registered dietician who specializes in pediatric IBD (IBD Anemia Working Group), after an extensive review of the current literature. The purpose of this review is to raise awareness of under-diagnosis of anemia in children with IBD and make recommendations for screening, testing, and treatment in this population.
贫血是炎症性肠病（IBD）最常见的肠道外表现之一。它可以是无症状的，也可以伴有非特异性症状，如烦躁、头痛、疲劳、头晕和食欲不振。在 IBD 患者中，贫血的病因通常是多因素的。各种原因包括缺铁、炎症和慢性疾病性贫血、维生素缺乏、溶血性贫血或药物的骨髓抑制作用。由于这些患者贫血和缺铁的发病隐匿、缺乏标准化的筛查实践，以及可能低估了治疗 IBD 时也需要治疗贫血，因此可能会被低估。由于不耐受，从业者可能会犹豫使用口服制剂，而由于担心不良反应、可用性和成本，静脉制剂的使用不足。近年来有几篇出版物记录了各种静脉制剂的安全性和疗效比较。本文回顾了儿童 IBD 患者贫血的管理，包括诊断、发病机制、患者评估、筛查和监测患者以早期发现和对治疗有反应的方案、治疗包括静脉补铁治疗以及慢性病性贫血的新治疗方法。本文由北美儿童胃肠病学、肝病学和营养学学会（NASPGHAN）IBD 委员会的一组儿科胃肠病学家与一名儿科血液病学家、药剂师和专门从事儿童 IBD 的注册营养师（IBD 贫血工作组）合作编写，对当前文献进行了广泛回顾。本文的目的是提高对儿童 IBD 患者贫血诊断不足的认识，并对该人群的筛查、检测和治疗提出建议。
