Handouts: Anemia & Inflammatory Bowel Disease

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Glossary
Anti-inflammatory drugs: Drugs that reduce signs and symptoms of inflammation

Erythropoietin: Hormone that regulates red blood cell production

Hematocrit: Percentage of red blood cells in a blood sample

Hemoglobin: Protein carried by red blood cells that transports and delivers oxygen throughout your body

IBD: Inflammatory bowel disease

Inflammation: Your body’s response to injury or irritation; often associated with pain, redness, heat, and/or swelling

What is anemia?
Anemia is a below-normal level of hemoglobin* or hematocrit*. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body. Anemia can be a temporary condition, a consequence of other health conditions, or it can be a chronic problem. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia may have problems carrying out routine activities and can feel tired or experience shortness of breath with activity.1

How common is anemia in people with IBD?
Studies show that at least 10% of IBD patients have anemia, and some estimates reach as high as 74%.1

What causes anemia in people with IBD?
There can be many reasons for a person with IBD to experience anemia. These include blood loss from the intestines or problems taking in and absorbing enough nutrients. These nutrients are the building blocks for all cells, including red blood cells. Another cause of anemia is the inflammation that occurs with IBD. Inflamed tissues give off small proteins which decrease the iron available for making red blood cells, interfere with the ability of the bone marrow to make red blood cells, and decrease the erythropoietin produced by your kidneys (hormone that regulates production of red blood cells).2,3 Red blood cells carry hemoglobin, and without enough red blood cells, anemia can develop.

What are the effects of untreated anemia in IBD?
Studies show people who have both IBD and anemia tend to have more severe IBD than people without anemia. Anemic people also have a higher mortality rate.4,5 While managing anemia may be life saving in some circumstances, treatment has not proven to guarantee a longer lifespan.

How do I know if I have anemia?
The best way to determine if you have anemia is to discuss your blood counts and changes in hemoglobin and hematocrit with your doctor. Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache. It is important to see your doctor on a regular basis in order to be tested for possible anemia.

What treatments are available to help me?
Since the inflammation associated with IBD often causes anemia, anti-inflammatory drugs used to treat your IBD may also treat your anemia. If you have low iron levels, your doctor may prescribe iron pills or intravenous infusions of iron.6 In certain cases, people have benefited from a combination of iron and drugs that stimulate the production of red blood cells.2,7 Close communication with your doctor will help him or her provide the treatment that is best for you based on what is causing the anemia.

*Normal Lab Values: Normal hemoglobin >12 g/dL for women, >13 g/dL for men; normal hematocrit >36% for women, >39% for men.

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References

  1. [Cited source redacted; replace with a supporting citation.]
  2. Gasché C, et al. Am J Gastroenterol. 2001;96:2382-2387.
  3. Oldenburg B, et al. Aliment Pharmacol Ther. 2001;15:429-438.
  4. Cucino C, Sonnenberg A. Inflamm Bowel Dis. 2001;7:250-255.
  5. Schreiber S, et al. N Engl J Med. 1996;334:619-623.
  6. Christodoulou D, Tsianos E. Eur J Intern Med. 2000;11:222-223.
  7. Cronin C, Shanahan F. Am J Gastroenterol. 2001;96:2296-2998.

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