Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience

Table 1 Subject characteristics (n = 92)

	Overall (n = 92)	Iron therapy			P value
		No iron (n = 18)	Oral iron (n = 17)	IV iron (n = 57)
Age (years), median (IQR)	15 (11–18)	13 (10–18)	15 (13–17)	15 (11–18)	0.70
Female sex, n (%)	41 (45)	10 (56)	7 (41)	24 (42)	0.63
IBD diagnosis, n (%)					0.008
CD	47 (51)	16 (89)	4 (24)	27 (47)
UC	41 (45)	2 (11)	11 (65)	28 (49)
IC	4 (4)	0 (0)	2 (12)	2 (4)
Disease duration (months), median (IQR)	1.4 (0.1–31.2)	19.6 (0.1–82.3)	1.0 (0.2–16.6)	1.5 (0.1-24.6)	0.58
CD phenotype, n (%)					0.41
Inflammatory	28 (60)	9 (56)	1 (25)	18 (67)
Fistula	10 (21)	4 (25)	2 (50)	4 (15)
Stricture	9 (19)	3 (19)	1 (25)	5 (19)
UC phenotype, n (%)					0.76
Pancolitis	34 (83)	2 (100)	10 (91)	22 (79)
Left-sided colitis	7 (17)	0 (0)	1 (9)	6 (21)

IQR: Interquartile range; IBD: Inflammatory bowel disease; IV: Intravenous; UC: Ulcerative colitis; CD: Crohn’s disease; IC: Indeterminate colitis.

Table 2 Iron studies (n = 92)

		Iron therapy			P value
		No iron (n = 18)	Oral iron (n = 17)	IV iron (n = 57)
Hb (g/dL)	Admission	10.4 ± 0.2	10.0 ± 0.2	9.7 ± 0.1
(n = 92)	Follow-up	11.2 ± 0.2	10.8 ± 0.2	11.6 ± 0.1
	Change	0.8 ± 0.3a	0.8 ± 0.3a	1.9 ± 0.2b	0.003
MCV (fL)	Admission	78.8 ± 0.8	78.6 ± 0.7	78.2 ± 0.4
(n = 92)	Follow-up	80.4 ± 0.8	81.4 ± 0.8	84.2 ± 0.4
	Change	1.6 ± 1.1a	2.8 ± 1.1a	6.0 ± 0.6b	0.0004
CRP (mg/dL)	Admission	3.8 ± 0.8	3.2 ± 0.8	4.0 ± 0.4
(n = 85)	Follow-up	1.9 ± 0.9	0.8 ± 0.9	0.8 ± 0.4
	Change	-1.8 ± 1.3	-2.4 ± 1.4	-3.2 ± 0.7	0.63
ESR (mm/1h)	Admission	48 ± 5	42 ± 5	44 ± 3
(n = 80)	Follow-up	31 ± 6	23 ± 6	27 ± 3
	Change	-17 ± 8	-20 ± 8	-16 ± 4	0.94
TIBC (μg/dL)	Admission	284 ± 19	296 ± 19	301 ± 9.1
(n = 64)	Follow-up	385 ± 35	404 ± 29	323 ± 10.7
	Change	101 ± 39a	108 ± 37a	23 ± 15a	0.04
Ferritin(μg/dL)	Admission	117 ± 30	82 ± 31	79 ± 15
(n = 66)	Follow-up	70 ± 58	15 ± 54	167 ± 18
	Change	-46 ± 61a	-67 ± 61a	88 ± 23b	0.02
Iron (μg/dL)	Admission	34.5 ± 6.9	26.6 ± 6.7	23.7 ± 3.2
(n = 65)	Follow-up	45.3 ± 12.8	53.4 ± 10.6	54.0 ± 3.8
	Change	10.7 ± 13.6	26.8 ± 12.3	30.3 ± 4.9	0.41

^aP < 0.05.

^bP < 0.01.

Effects with different superscripts are statistically significant, mean ± standard error at admission, follow-up encounter, and change over time are shown. Results are from a repeated measures linear model adjusted for baseline outcome, age at admission, sex, diagnosis, baseline iron dose, and the number of days between admission and follow-up labs. After adjustment for multiple comparisons, the differences between total iron binding capacity and ferritin are not significant. Hb: Hemoglobin; MCV: Mean corpuscular volume; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; TIBC: Total iron binding capacity.

Table 3 Comparison of intravenous iron types (n = 57)

		Iron therapy			P value	Difference (95%CI)
		Venofer (n = 19)	Injectafer (n = 16)	INFeD (n = 22)		Injectafer-Venofer	INFeD-Venofer	Injectafer-INFeD
Hb (g/dL)	Admission	9.4 ± 0.3	9.5 ± 0.2	9.4 ± 0.2
(n = 57)	Follow-up	10.5 ± 0.3	11.9 ± 0.2	11.7 ± 0.2
	Change	1.0 ± 0.3a	2.4 ± 0.3b	2.2 ± 0.3b	0.009	1.3 (0.2, 2.5)a	1.2 (0.1, 2.3)a	0.1 (-1.0, 1.2)
Ferritin (μg/dL)	Admission	117 ± 36	82 ± 33	73 ± 36
(n = 43)	Follow-up	153 ± 39	183 ± 45	206 ± 42
	Change	37 ± 43	101 ± 57	133 ± 44	0.3	64 (-118, 247)	96 (-61, 254)	-32 (-215, 151)
Iron (μg/dL)	Admission	19.2 ± 6.5	23.0 ± 5.8	25.3 ± 6.5
(n = 43)	Follow-up	27.5 ± 7.0	80.7 ± 8.0	67.1 ± 7.4
	Change	8.3 ± 7.1a	57.7 ± 9.7b	41.7 ± 7.3b	0.0006	49.4 (18.5, 80.2)c	33.5 (7.4, 59.6)b	15.9 (-15.0, 46.8)

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Effects with different superscripts are statistically significant at P < 0.05, mean ± standard error at admission, follow-up encounter, and change over time are shown. Results are from a repeated measures linear model adjusted for baseline outcome, age at admission, sex, diagnosis, baseline iron dose, and the number of days between admission and follow-up labs. The 95% confidence interval is adjusted for multiple comparisons using the Bonferroni step-down procedure. Hb: Hemoglobin; CI: Confidence interval; INFeD: Low-molecular-weight iron dextran.