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 1830% of these patients receive intravenous (IV) Fe replacement . The preferred route of supplementation in CD is IV as this is more effective and better tolerated than oral Fe . In this study we have analysed:
- the proportion of CD patients undergoing serum ferritin analysis over a 1 year period
- the number of CD patients with Fe deficiency/Fe deficiency anaemia
- correlation between location of CD and Fe deficiency
- whether CD patients with Fe deficiency were treated with IV Fe
- 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%).
|Normal Se Ferritin||Low Se Ferritin (<30 ng/mL)||Se Ferritin Not Analysed|
|No of patients||29||26||68|
|Disease Location||L1 (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 >6||20.7% (6)||26.9% (7)||19.1% (13)|
|On IV Fe||3.4% (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  Fe appropriately.
1. J. Stein et al. (2011), Current European practice in diagnosis and treatment of IBD-associated anaemia. JCC Volume 5(1), S4546.
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.