P258 Prevalence of anemia at presentation in pediatric Crohn's Disease patients: single center experience
R. Jotta*, S. Azevedo, H. Loreto, P. Mourato, A.I. Lopes
Unit of Gastroenterology, Department of Pediatrics, Santa Maria Hospital - CHLN, Academic Medical Center of Lisbon, Lisbon, Portugal
Anemia is a frequent extra-digestive manifestation of inflammatory bowel disease (IBD), in both pediatric and adult patients with IBD and especially in Cronh's disease (CD). Iron deficiency (IDA) and anemia of chronic disease (ACD) play a major role in these patients. Although prevalence of anemia in IBD in adult patients has been reported in different settings (active disease vs disease in remission, hospitalized vs ambulatory patients), its true prevalence in pediatric patients is not yet well known and recent studies suggest it may be higher than in adult patients.
This study aimed to evaluate the prevalence of anemia (global prevalence, IDA and ACD prevalence) in newly diagnosed CD pediatric patients in a single pediatric center.
Retrospective and descriptive study of newly diagnosed pediatric CD patients referred to a Gastroenterology Pediatric Unit during January 2001-November 2014. Anemia was defined according to OMS criteria. Distinction between IDA and ACD was established according to hematological parameters, serum ferritin, transferrin saturation and ESR. Symptoms previous to diagnosis, Paris classification and disease activity (PCDAI) were determined in all patients and data collected from clinical registries.
During the study period, CD diagnosis was established in 56 pediatric patients (33 male), median age: 17 years (25-7), median age at diagnosis: 12 years (18-0,2); median follow-up time is currently 54.5 months (166-1,2). Concerning anemia diagnosis, 42 patients were included (14 excluded - missing data). At presentation, anemia was documented in 32 patients (76,2%). Ten patients (all with mild disease) had no anemia at diagnosis (median hemoglobin (Hb) 13,8g/dL [16,1-12,7], ferritin 69mg/dL [125,8- 26,1] and ESR 31mm/h [62-8]). Of the 32 patients with anemia, 16 (50%) had IDA (median Hb 10.7g/dL [11,9-7,2], median ferritin 34,7mg/dL [75,2-4,1] and median ESR 46mm/h [93-2]); considering disease activity (11/16)-moderate:8, mild:3; and 6 of them (6/16, 37,5%) had ileal involvement. Sixteen patients had ACD (median Hb 10,9g/dL [12-7,7], median ferritin 220mg/dL [850-108,4], median ESR 71mm/h [120-11]); regarding disease activity (14/16)-severe:2, moderate:9, mild:3; and 9 of them had ileal involvement (9/16, 56,3%).
Considering duration of symptoms before diagnosis, patients with anemia had a median duration of 3 months (87-0) and patients without anemia a median of 2 months (41-0).
The Results of this single center study are consistent with the current scientific evidence. As expected, both IDA and ACD anemia were frequent at pediatric CD presentation, although ACD was more prevalent in patients with more active disease. A similar disease location was observed in both IDA or ACD patients.