Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Mar 9, 2024; 13(1): 89318
Published online Mar 9, 2024. doi: 10.5409/wjcp.v13.i1.89318
Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience
Krishanth Manokaran, Jonathan Spaan, Giulio Cataldo, Christopher Lyons, Paul D Mitchell, Tatyana Sare, Lori A Zimmerman, Paul A Rufo
Krishanth Manokaran, Jonathan Spaan, Giulio Cataldo, Christopher Lyons, Tatyana Sare, Lori A Zimmerman, Paul A Rufo, Center for Inflammatory Bowel Disease, Boston Children's Hospital, Boston, MA 02115, United States
Paul D Mitchell, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA 02115, United States
Co-first authors: Krishanth Manokaran and Jonathan Spaan.
Author contributions: Manokaran K and Spaan J contributed equally to this work; Rufo PA conceptualized the study; Rufo PA, Manokaran K, and Spaan J conceived methodology; Mitchell PD performed formal statistical analysis; Manokaran K, Spaan J, Cataldo G, and Lyons C performed data collection; Manokaran K, and Spaan J prepared original draft; Rufo PA, Mitchell PD, and Zimmerman LA helped review and edit manuscript; Rufo PA and Sare T provided resources and project administration; All authors have read and agree to the published version of the manuscript.
Institutional review board statement: This study was review and approved by the Boston Children's Hospital Institutional Review Board, No. P00024515.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Paul.Rufo@childrens.harvard.edu. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paul A Rufo, MD, Assistant Professor, Center for Inflammatory Bowel Disease, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States. paul.rufo@childrens.harvard.edu
Received: October 27, 2023
Peer-review started: October 27, 2023
First decision: December 17, 2023
Revised: January 7, 2024
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: March 9, 2024
Processing time: 131 Days and 11.7 Hours
ARTICLE HIGHLIGHTS
Research background

Screening for iron deficiency anemia (IDA) is uniformly recommended but may not always occur in the management of pediatric patients with acute exacerbation of their inflammatory bowel disease (IBD). In addition, clinicians may be hesitant to use intravenous (IV) iron in practice in the active IBD population due to concerns about adverse reactions reported in prior IV formulations. Our study sought to evaluate the efficacy and safety profile of IV iron therapy in pediatric patients with IDA admitted to our tertiary care center for their active IBD.

Research motivation

The significance of this research is that it provides additional data on the efficacy and safety profile of the newer IV iron preparations in pediatric patients with active IBD. This research will provide data in directing management of pediatric patients with IDA and active IBD.

Research objectives

The primary aim of this observational study was to prospectively evaluate the efficacy and safety of IV iron therapy for managing IDA in pediatric patients admitted to our center to manage clinical exacerbation of their IBD. The significance of achieving these objectives will allow providers caring for such patients to know the efficacy and safety profile of the newer iron preparations and possible expected outcomes.

Research methods

We performed a prospective, open-label, observational cohort study to evaluate our study aims. Research Study Coordinators reviewed the inpatient census daily to assess patient laboratory studies. They notified clinical staff of patients meeting the criteria for iron deficiency and provided them with information about the IV iron formulations available on the hospital formulary and dosing guidelines using a standardized electronic template. The inpatient team subsequently made all decisions concerning the preparation and dose of IV or oral iron prescribed for individual patients. The observational longitudinal cohort design allows us to evaluate changes in hemoglobin (Hb) and iron levels over time in individuals and groups of patients.

Research results

First, we found that IV iron is more efficacious than oral or no iron therapy in increasing Hb levels by their first ambulatory follow-up after receipt of iron therapy. This suggests that IV iron therapy is a more efficacious option in elevating Hb levels by the time of first ambulatory follow-up. Second, we found that IV iron was overall a safe option in the repletion of IDA in this pediatric IBD population with only 1/57 adverse events reported. This suggests that IV iron is a safe option in this patient population. Third, IDA did not resolve in patients who had otherwise responded favorably (comparable decreases in erythrocyte sedimentation rate and C-reactive protein levels) to medical therapy. In contrast to previous tenets suggesting that iron deficiency would resolve when the underlying inflammation was corrected, our data suggest that in the absence of targeted iron therapy, correction of the underlying inflammatory response is insufficient to resolve iron homeostasis in patients with IBD.

Research conclusions

Our single-center study shows that IV iron is safe and efficacious in treating IDA in children with active IBD. Our data further demonstrate that addressing inflammation is insufficient to correct iron deficiency and that successful treatment of iron deficiency in pediatric patients with IBD warrants active management.

Research perspectives

More extensive prospective studies are needed to investigate further the efficacy and safety of IV iron therapy in IDA in children with IBD.