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P462. Iron deficiency anemia in pediatric Crohn's disease: preliminary evaluation of parenteral iron therapy

M. Valente Pinto1, S. Azevedo1, H. Loreto1, P. Mourato1, C. Maltez1, A.I. Lopes1, 1Academic Medical Center of Lisboa, Pediatric Department – Santa Maria Hospital – CHLN, Lisboa, Portugal

Background

Iron deficiency anemia (IDA) is one of the most prevalent causes of anemia in IBD patients, particularly in pediatric group. Low levels of hemoglobin (hb) could affect the quality of life in this group and thus an active approach has been recommended. Although the efficacy and safety of parenteral iron have been shown in adult studies, data concerning childhood are still scarce and the best iron therapy is not yet established.

Methods

Pediatric patients with Crohn's disease (CD) (according to Porto Criteria and phenotype classification according to Paris Classification) and IDA (WHO criteria) were prospectively recruited, during an 18 month period. All patients were treated with intravenous iron sucrose, and the total dose was determined according to Ganzoni formula. To evaluate the response to therapy, hb and serum ferritin level were determined 4–6 weeks after the last infusion.

Disease activity (Paediatric Crohn's Disease Activity Index – PCDAI) was determined before and after treatment. Clinical tolerance and adverse effects were reported.

Results

14/46 patients (30.4%) with CD (10 female; mean age: 14.8±2.1 [11–18] years), were recruted. The mean age at diagnosis was 11.4±2.2 [7–15] years. At the time of recruitment, mean PCDAI was 17.9±12 [2.5–40]), and 6 patients were in remission; 6 patients were under oral iron therapy.

According to WHO age and sex cut-off levels, results were: females >13 years: n = 9, mean Hb: 10.1±1.3 g/dl; males >13 years: n = 4, mean Hb: 11.5±1.3 g/dl; female <12 years: n = 1; Hb: 11.6 g/dl. The mean serum ferritin values in the remission group and in the active disease group, were respectively: 11.3±7.4 ug/dl [5.4–23.5] and 46.6±85.2 ug/dl [0.7–252].

After iron therapy, all patients were in remission (mean PCDAI: 4.2±3.7[0–12.5]), with a mean serum ferritin level of 64.3±40.7 ug/dl [24.1–176.8]. The mean Hb levels raised in all groups (females >13 years: mean Hb: 12.6±0.9 g/dl; males >13 years: mean Hb: 13.6±0.8 g/dl; female <12 years:Hb: 14.4 g/dl).

Iron therapy was well tolerated, without adverse effects.

The mean iron dosage was 734±197.1 mg. 3 patients required a further treatment cycle, within a mean follow-up period of 6.3 months [3–10].

Conclusion

These preliminary data suggest that parenteral iron is a safe and effective treatment for IDA in pediatric CD. The Ganzoni formula seems to be adequate in this study population. Longterm follow-up studies will elucidate the clinical impact of this treatment strategy.