Anaemia in Children With IBD: A Persistent Challenge

TOPLINE:

More than one third of children with inflammatory bowel disease (IBD) presented with anaemia at diagnosis, with the prevalence of anaemia being higher in those with Crohn’s disease than in those with ulcerative colitis. More than 20% of children remained anaemic after 1 year.

METHODOLOGY:

• Researchers conducted a retrospective observational study using registry data from Italy (January 2009 to April 2021) to examine the prevalence and characteristics of anaemia in children younger than 18 years newly diagnosed with IBD and anaemia.
• They included 1634 patients with IBD, of whom 748 had Crohn’s disease and 886 had ulcerative colitis.
• IBD was diagnosed on the basis of the Porto criteria, and data on treatment received were collected.
• On the basis of the World Health Organization criteria, anaemia was diagnosed and graded as follows:
  • Mild: Haemoglobin levels of 10-10.9 g/dL for children younger than 5 years, 11-11.9 g/dL for children aged 5-14 years and non-pregnant girls older than 15 years, and 11-12.9 g/dL for boys older than 15 years.
  • Moderate: Haemoglobin levels of 7-9.9 g/dL for children younger than 5 years and 8-10.9 g/dL for all others.
  • Severe: Haemoglobin levels < 7 g/dL for children younger than 5 years and < 8 g/dL for all others.
• Laboratory parameters, such as haemoglobin and/or ferritin levels and/or transferrin saturation, were assessed at the time of inclusion and at the 1-year follow-up.

TAKEAWAY:

• The prevalence of anaemia was 36% and was significantly higher in children with Crohn’s disease than in those with ulcerative colitis (39% vs 33%; P = .009); 55% of children presented with moderate anaemia and 81% presented with microcytic anaemia.
• Severe anaemia was more common in children with ulcerative colitis than in those with Crohn’s disease (13.2% vs 5.7%; P = .0019), while a higher proportion of children with Crohn’s disease had mild anaemia than those with ulcerative colitis (P < .0001).
• Children with Crohn’s disease and moderate anaemia experienced symptoms at an earlier age than those with mild anaemia (P = .0008). Severe disease was more common in children with severe anaemia than in those with mild (P = .01) or moderate (P = .001) anaemia.
• At the 1-year follow-up, 22.9% of children remained anaemic, with no significant difference observed between those with Crohn’s disease and those with ulcerative colitis. 

IN PRACTICE:

“Despite recommendations and increased awareness raised by organizations such as ECCO [European Crohn’s and Colitis Organisation], there remains insufficient attention to and therapeutic management of this issue. This is particularly critical in children, as unrecognized and untreated iron deficiency can significantly impact their development and cognitive performance,” the authors wrote.

SOURCE:

This study, led by Giulia D’Arcangelo, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy, was published online on March 31, 2025, in the Journal of Pediatric Gastroenterology and Nutrition.

LIMITATIONS: 

Data on transferrin and transferrin saturation were incomplete, and data on soluble transferrin receptors were absent. The exclusion of many patients due to incomplete data at diagnosis might have affected the comprehensiveness of the results. The absence of a non-anaemic control group limited the scope of observations.

DISCLOSURES:

This study did not receive any specific funding, and the authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.