Safety and Efficacy of Parenteral Iron in Children with Inflammatory Bowel Disease

Michael Papadopoulos, Deepa Patel, Roxanna Korologou-Linden, Goto Eunice, Krishna Soondrum, John Fell, Jenny Epstein

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Objectives:
Iron deficiency anemia (IDA) frequently complicates inflammatory bowel disease (IBD) in children and adults. Oral iron may exacerbate gastrointestinal symptoms and absorption may be insufficient in intestinal inflammation. Even where oral iron is successful, repletion of iron stores can be unacceptably slow. Intravenous (IV) iron compounds were in the past associated with serious adverse reactions and historically were considered a last resort in children. New generation preparations have a safer profile in adults although reluctance to use them in children may persist, where safety data is lacking. We investigate the safety and efficacy of ferric carboxymaltose (FCM) and iron sucrose (IS) in children.

Methods:
We retrospectively identified all children with IBD who received parenteral iron over a 38 month period in a single regional referral centre. Safety, tolerability and adverse events were established by case note review. Efficacy was assessed by change in hematinic indices pre- and post-treatment.

Results:
47 children (18 male; median age 14yrs, range 3-17) received a total of 104 iron infusions. 44% (21) had Crohn’s disease (CD); 56% (27) ulcerative colitis (UC). 40 received FC, eight IS and one both. Three children developed mild rash post infusion which resolved quickly with chlorphenamine. Mean increase in hemoglobin (Hb) was 2.5g/dl (0.3-5.8). Iron levels increased by a mean of 8.4 g/dl (1-25), transfer in saturation by 16.2% (2-47). Transfer in decreased by 0.84 g/dl (0.3-3.4).

Conclusion:
New generation parenteral iron preparations are safe, well tolerated and efficacious in children with IDA and IBD.

What is known:
Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) and a significant contributor to morbidity.
IDA should be actively treated in IBD.
Parenteral iron is effective and relatively safe in adults.

What is new:
The intravenous iron preparations ferric carboxymaltose (FCM) and iron sucrose (IS) are effective treatments for IDA in children with IBD. The safety profiles of FCM and IS are favourable, and similar in children to that in adults.
Original languageEnglish
Article number1011
Number of pages6
JournalJournal of Gastroenterology, Hepatology, and Endoscopy
Volume2
Issue number2
Early online date10 Jul 2017
Publication statusPublished - Jul 2017

Keywords

  • Iron deficiency anemia
  • Ferric carboxymaltose
  • Iron sucrose
  • Intravenous iron
  • Pediatric

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