Advances in the diagnosis and treatment of inflammatory bowel disease-associated anemia in children

doi:10.3969/j.issn.1674-8115.2025.09.015

Abstract

Abstract:

Inflammatory bowel disease (IBD) is a group of non-specific chronic gastrointestinal inflammatory disorders of unknown etiology. Patients with IBD often have a variety of extraintestinal symptoms and complications. Anemia is one of the most common extraintestinal manifestations, and its incidence and prevalence in children are higher than in adults. Anemia in children with IBD not only causes non-specific symptoms such as dizziness, headache, and fatigue, but also impacts growth and development, and is closely related to the quality of life. The etiologies of IBD-associated anemia include iron deficiency, anemia of chronic disease, vitamin deficiency, hemolysis, and myelosuppression, among which iron deficiency is the most common. In recent years, in addition to conventional indicators such as hemoglobin, hematocrit, and mean corpuscular hemoglobin, many new indicators for evaluating anemia and iron deficiency have emerged, including soluble transferrin receptor (sTfR), the ratio of sTfR to log ferritin (sTfR-F) index, and reticulocyte hemoglobin content (CHr). In the treatment of IBD-associated anemia in children, oral iron supplementation is the most commonly used therapy in clinical practice, while intravenous iron therapy is not widely used. Although anemia has many negative effects on children with IBD, its diagnosis and treatment are often delayed. This article reviews the pathogenesis, diagnosis, and treatment of IBD-associated anemia in children, in order to improve clinical awareness and attention, and provide a basis for further improving the treatment effect and quality of life.

Key words: inflammatory bowel disease (IBD), anemia, child

CLC Number:

R725.7

WANG Zhiqi, WANG Ying. Advances in the diagnosis and treatment of inflammatory bowel disease-associated anemia in children[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(9): 1232-1238.

Figures/Tables 1

TrendMD

References 56

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Biomarker	Clinical significance	Cut-off for iron deficiency	Advantage	Limitation
Serum ferritin	Iron storage	<5 years: serum ferritin<12 μg·L^-1; ≥5 years: serum ferritin<15 μg·L^-1	Direct measure of stored iron	Affected by inflammation
TSAT	Iron utilization efficiency	<16%	Less influenced by inflammation	Cannot distinguish IDA from ACD
sTfR	Erythroid marrow iron demand	>8 mg·L^-1	Unaffected by inflammation	Lack of standardized assays
sTfR-F index	Integrated iron status	CRP<5 mg·L^-1: sTfR-F>1.5; CRP≥5 mg·L^-1: sTfR-F>0.8	High specificity	No universal reference ranges
CHr	Iron availability	<31 pg	More sensitive	Affected by inflammation

Biomarker	Clinical significance	Cut-off for iron deficiency	Advantage	Limitation
Serum ferritin	Iron storage	<5 years: serum ferritin<12 μg·L^-1; ≥5 years: serum ferritin<15 μg·L^-1	Direct measure of stored iron	Affected by inflammation
TSAT	Iron utilization efficiency	<16%	Less influenced by inflammation	Cannot distinguish IDA from ACD
sTfR	Erythroid marrow iron demand	>8 mg·L^-1	Unaffected by inflammation	Lack of standardized assays
sTfR-F index	Integrated iron status	CRP<5 mg·L^-1: sTfR-F>1.5; CRP≥5 mg·L^-1: sTfR-F>0.8	High specificity	No universal reference ranges
CHr	Iron availability	<31 pg	More sensitive	Affected by inflammation