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P151. Routine anaemia management differs substantially between Eastern European countries and is not in line with treatment recommendations

M. Lukas1, G. Rydzewska2, M. Diculescu3, J. Lange4, D. Mitchell4, 1IBD Clinical and Research Centre, ISCARE Lighthouse, Charles University, Prague, Czech Republic, 2Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warszawa, Poland, 3Gastroenterology and Hepatology Centre, Fundeni Clinical Institute, Bucharest, Romania, 4Vifor Pharma, Glattbrugg, Switzerland

Background

Iron deficiency anaemia (IDA) has a negative impact on quality of life and increases the risk of hospitalisation in IBD patients. Intravenous (i.v.) iron substitution is the recommended treatment; however data on its use in Eastern Europe, are limited. This study evaluated the current practice in diagnosis and treatment of IDA in IBD patients in Eastern European countries.

Methods

Gastroenterologists (GEs) from Bulgaria, Czech Republic, Poland, Romania, Russia, Slovakia, and Slovenia participated in the survey about diagnostic parameters and IDA therapy used for the last five IBD patients that have been treated for anaemia in the six months prior to the survey (Jan-Feb 2012). Data are shown as total or median of all patients and range across countries.

Results

179 GEs reported 951 IBD cases with IDA (62% with ulcerative colitis, 54% female, mean age 42 years). Of 623 patients, presenting at hospital-based GEs, 34% were hospitalised. At diagnosis, almost all patients were tested for haemoglobin (Hb; 97% [92–100%]). Serum ferritin and transferrin saturation (TSAT) were only tested in 30% (21–51%) and 11% (0–22%), respectively. Median Hb was 9.9g/dL (9.2–10.1g/dL), ferritin 29 ng/mL (19–82 ng/mL) and TSAT 11% (9–30%). Moderate-to-severe anaemia (Hb ≤10 g/dL) was diagnosed in 67% (50–79%) of patients; 10% (0–15%) presented with Hb <8g/dL. Absolute iron deficiency (ferritin ≤30 ng/mL) was seen in 53% (29–73%), and 81% (33–100%) of tested patients had insufficient availability of iron (TSAT ≤20%). Almost all patients (95% [92–100%]) received iron treatment within 12 months prior the survey. However, apart from Slovenia (65%), only a minority (17% [1–28%]) have received i.v. iron. Patients with initial Hb <8g/dL, received i.v. iron more often (36% [11–100%]). Orally, a mean total dose of 15.0g (5.0–21.5g) iron was given over 16 weeks (6–26 weeks). Notably, 5% (0–10%) received intramuscular (i.m.) iron. Blood transfusions or erythropoiesis-stimulating agents were given in 11% (0–17%) and 7% (0–35%) of patients, respectively.

Conclusion

Despite i.v. iron therapy is recommended to treat IDA in IBD patients, the current clinical practice is far from optimal. Iron substitution is mainly based on oral iron, even in severely anaemic patients. The high frequency of IDA in this cohort indicates insufficient monitoring or repletion of iron status. Broader implementation of evidence-based recommendations for IDA management in patients with IBD is needed.