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P192 Prevalence and causes of anaemia in patients with Inflammatory Bowel Diseases in Southern Italy

A. Testa*1, A. Rispo2, M. Romano3, G. Riegler4, F. Selvaggi5, E. Bottiglieri6, M. Martorano7, M. Rea1, A.G. Gravina7, M. Patturelli4, G. Pellino5, N. Caporaso2, F. Castiglione8

1AOU FEDERICO II, Clinical medicine and surgery, Naples, Italy, 2AOU FEDERICO II, Clinical Medicine and Surgery, Naples, Italy, 3Second University of Naples, Gastroenterology Unit, Department of Clinical and Experimental Medicine, Naples, Italy, 4Second University of Naples, Gastroenterology, Naples, Italy, 5Second University of Naples, Surgery, Naples, Italy, 6Hospital of Marcianise, Gastroenterology, Caserta, Italy, 7Hospital of Sapri, Gastroenterology, Sapri, Italy, 8AOU FEDERICO II, Gastroenterology, Naples, Italy

Background

Anaemia (AN) is frequently associated with inflammatory bowel diseases (IBD) with a prevalence varying from 17% to 68%. In recent years, the management of AN in IBD has became a major issue as it negatively affects both the underlying disease and the quality of life of affected patients. Our aim was to evaluate the prevalence and causes of AN in patients with IBD living in a region of Southern Italy.

Methods

We prospectively performed a one-year multicentre study in Campania (Italy) including all consecutive IBD cases attending 5 Units. AN was defined in presence of haemoglobin values Hb <13 g/dl for males and Hb <12 g/dl for females; severe AN was defined in case of Hb <10 g/dl. To explore the causes of AN, all anaemic patients underwent a second-line haematological assessment including ferritin, transferrin, vitamin B12, folic acid and homocysteine levels and screening for celiac disease (total IgA and anti-transglutaminase antibodies). Furthermore, in all IBD cases CRP and ESR were evaluated. Iron deficiency AN (IDA) was diagnosed in case of ferritin <30 ng/ml and transferrin saturation (TSAT) <16%. AN of chronic disease (ACD) was diagnosed when elevated CRP/ESR values coexisted with TSAT < 16% and ferritin >100 ng/ml; mixed type AN was considered in case of TSAT <16% and 30 ng/ml < ferritin < 100 ng/ml.

Results

The study population included 965 IBD patients (582 CD; 383 UC) of whom 142 in- and 823 out-patients. AN was diagnosed in 134 out 965 IBD patients (14%). No significant difference was seen between CD and UC groups (81 CD vs 53 UC; 13.9% vs 13.8%; p=n.s.). The prevalence of AN was more frequent in the admitted IBD group (26% in- vs 11.7% out-patients; p<0.01; O.R. 2.2) and in patients with active disease (CD: 34% active vs 16% in remission; p<0.01; OR 2.1 - UC: 26% active vs 19% in remission; p=0.03; O.R. 1.3). Furthermore, AN appeared to be more frequent in patients with ileo-colic CD and in those with extensive UC (p<0.01). Regarding the causes of AN, IDA was present in 72 patients (53.7%), ACD in 12 patients (8.2%), 11 patients (8.2%) had mixed type AN, 9 had thalassemia (6.7%), 8 (5.9%) had macrocytic AN, while in 18 patients (13.4%) the causes remained unclassifiable. Vitamin B12 deficiency was observed in 7.4% of CD patients and in no case of UC. Folic acid deficiency was detected in 6.1 % of CD and in none of the patients with UC. There was no evidence of celiac disease.

Conclusion

AN is common among patients with IBD in Southern Italy and is more frequent in IBD patients with active and extensive disease and in whom needing hospitalization. Iron deficiency still remains the major cause of AN in IBD population.