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P190 Anaemia and iron deficiency in a tertiary IBD centre in Brazil: prevalence and significancy

R. S. Parra*1, M. R. Feitosa1, S. C. Ferreira2, R. S. Rodrigues1, A. Favoretto Jr1, B. E. Caetano1, O. Féres1, J. J. Ribeiro da Rocha1, L. E. d. A. Troncon2

1Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil, Surgery and Anatomy, Ribeirão Preto, SP, Brazil, 2Ribeirão Preto Medical School, University of São Paulo, Division of Gastroenterology, Department of Medicine, Ribeirão Preto – SP, Brazil

Background

Anaemia and iron deficiency anaemia (IDA) has been known to cause significant functional impairment, lower quality of life, higher morbidity and mortality. The aim of this study was to estimate the prevalence and significance of anaemia and IDA in patients with IBD in a tertiary IBD unit in Southeast Brazil

Methods

Retrospective analysis from the adult population‐based IBD cohort of Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Brazil, consisting of 579 patients, between January 2014 through July 2018. Medical records consisted of haemoglobin measurements and serum ferritin extracted from the hospital data system. We also compared the phenotype in Crohn's disease (CD) and the extension of ulcerative colitis (UC) with the anaemia prevalence. WHO criteria defined anaemia. IDA was evaluated using ferritin and C reactive protein (CRP).

Results

Of 579 patients, 529 had complete blood count available at medical records and 205 patients had IDA calculated. Means that during this 4-year median follow-up period, only 35.5% of patients with IBD (41.5% in CD and 35.2% in UC) were fully screened for anaemia. Table 1 summarises the patient’s characteristics.

Table 1. Patient’s characteristics (n = 529).

Value
Female (%)47.5
Mean age (years)45.4
Anaemia in ulcerative colitis (UC) (%)19.1
Anaemia in Crohn’s disease (CD) (%)29.1
Moderate to severe anaemia (UC) (%)11.4
Moderate to severe anaemia (CD) (%)19.8
Iron deficiency anaemia (UC) (%)57.2
Iron deficiency anaemia (CD) (%)53.6

CD was associated with an increased prevalence of anaemia (p = 0.008; OR = 1.76; CI 95%: 1.16–2.66) compared with ulcerative colitis. Penetrant disease phenotype in CD was associated with a lower risk of anaemia (p < 0.0001; OR = 0.25; CI 95% = 0.14–0.43). Active disease when compared with the disease in clinical remission was associated with an increased risk of anaemia (p = 0.0003; OR: 2.61; CI 95% = 1.56–4.36) in CD. Presence of anaemia was less frequent in patients with CD who underwent surgical resection compared with those who did not undergo surgery (p < 0.0001; OR = 0.24; CI 95%: 0.14–0.40). Differences were not observed in the presence of anaemia and localisation of Crohn's disease, age at diagnosis, extension of UCU, and use of biological (p > 0.05). This results are summarised in Table 2.

VariableOR; CI 95%p-value
CD1.76 (1.16–2.66)0.008
Penetrant disease phenotype (CD)0.25 (0.14–0.43)<0.0001
Active disease (IBD)2.61 (1.56–4.36)0.0003
CD who underwent surgical resection0.24 (0.14–0.40)<0.0001

Factors associated with higher/lower risk of anaemia. IBD = inflammatory bowel disease; CD = Crohn's disease.

Conclusion

Anaemia is a common manifestation of IBD. However, screening for anaemia and, in particular, iron deficiency, are rarely performed. CD is associated with an increased risk of anaemia, especially with active disease.1

References

1. Eriksson C, Henriksson I, Brus O, et al., Incidence, prevalence and clinical outcome of anaemia in inflammatory bowel disease: a population-based cohort study. Aliment Pharmacol Ther 2018;48:638–45, doi: 10.1111/apt.14920