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P215. Iron deficiency in Crohn's: Serum ferritin, disease location, and inflammatory markers

N. Azzopardi1, P. Ellul1, V. Fenech1

1Mater Dei Hopsital, Gastroenterology Department, Msida, Malta

Background: The major cause of anaemia in Crohn's disease (CD) is iron (Fe) deficiency. A European study on 1137 patients with Inflammatory Bowel Disease has shown that Fe deficiency is present in 81% of patients tested but only 18–30% of these patients receive intravenous (IV) Fe replacement [1]. The preferred route of supplementation in CD is IV as this is more effective and better tolerated than oral Fe [2]. In this study we have analysed:

  1. the proportion of CD patients undergoing serum ferritin analysis over a 1 year period
  2. the number of CD patients with Fe deficiency/Fe deficiency anaemia
  3. correlation between location of CD and Fe deficiency
  4. whether CD patients with Fe deficiency were treated with IV Fe
  5. correlation between C‑Reactive Protein (CRP) and low serum ferritin in CD patients

Methods: 123 patients (60 male) with CD were identified through the gastroenterology out-patients database. Haemoglobin, CRP and serum ferritin level were analysed through isoft® (April 2010-April 2011).

Results: Serum ferritin was analysed in 32 out of 63 female patients (50.8%) and in 23 out of 60 male patients (36.7%).

L1: ileal disease, L2: colonic disease, L3: ileocolonic disease.
 Normal Se FerritinLow Se Ferritin (<30 ng/mL)Se Ferritin Not Analysed
No of patients292668
Disease LocationL1 (13.6%), L2 (59.1%), L3 (27.3%)L1 (19%), L2 (28.6%), L3 (52.4%)L1 (30.2%), L2 (30.2%), L3 (39.6%)
Hgb (<11.5 g/dL Females; <13 Males)10.3% (3)42.3% (11)14.7% (10)
CRP >620.7% (6)26.9% (7)19.1% (13)
On IV Fe3.4% (1)3.8% (1)

Conclusions: Only 51 patients (41.5%) had their serum ferritin analysed in the period under study and only 1 patient with low ferritin and anaemia was treated with IV Fe. Low serum ferritin was found in 47.4% of patients tested. 27% of patients with evidence of low ferritin had an elevated CRP while 21% of patients with normal ferritin had an elevated CRP, suggesting a poor correlation between serum ferritin and CRP. A significant correlation between ileal involvement and low serum ferritin was found (χ2 P value <0.05). Patients with CD should undergo regular serum ferritin assessment and should be replaced with oral/intravenous [2] Fe appropriately.

1. J. Stein et al. (2011), Current European practice in diagnosis and treatment of IBD-associated anaemia. JCC Volume 5(1), S45–46.

2. Gasche C, Berstad A, Befrits R et al. (2007), Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflammatory Bowel Disease, 1545e53.