Treatment options for iron deficiency in IBD
It is likely that if you have been diagnosed with IBD that you will have regular follow-up appointments with your doctor to check how you are feeling and to monitor the progress of your symptoms. If you have been feeling fatigued or have any of the symptoms of iron deficiency such as paleness, faintness or a racing heart, you may want to make an extra appointment or speak to your doctor about your symptoms at your next scheduled visit.
To get the most out of your visit, think in advance about the information that the doctor might need in order to work out what is causing your symptoms. You should also prepare any questions that you want to ask. For example, it may be useful for the doctor to know1,2
- How your IBD symptoms currently are
- What medications you are on
- How well you have been sleeping
- How much exercise you have been doing, and
- If there is any life situation that is currently making you stressed
Questions that you might want to ask your doctor include:
- I feel tired most of the time. Do you think I have anaemia?
- Has my haemoglobin/ ferritin level been checked recently? If so, what did the results show?
- If I have anaemia, which treatment would suit me best?
- How can I avoid getting anaemia again?
How will your doctor test for iron deficiency and iron deficiency anaemia?
If you have IBD, it is likely that you have regular blood tests to check your Complete Blood Count (CBC)3. This blood test can be used to find out if you are anaemic. Further blood tests can also be done to find out if you are iron deficient. If you are found to be iron deficient or anaemic and you are given treatment, your blood may still be tested on a regular basis to make sure that your red blood cell levels are improving.
Anaemia occurs when there are fewer healthy red blood cells in your blood or you have low haemoglobin levels4. Haemoglobin carries oxygen in the blood from the lungs to the rest of the body. Your doctor can check whether or not you are anaemic by performing a Complete Blood Count. This helps your doctor to find out the number of red blood cells and amount of haemoglobin in your blood5.
The table beneath shows the haemoglobin level that may be considered ‘low’ by your doctor. The cut-off values that define anaemia can be different for different groups of people.
| Gender/Age | Blood Test | Guideline Values your Doctor may use when Checking for Anaemia |
|---|---|---|
| Men > 15 years old | Haemoglobin count to define anaemia | Below 13 g/dL6 |
| Women > 15 Years old (non-pregnant) | Haemoglobin count to define anaemia | Below 13 g/dL6 |
| Women > 15 years old (pregnant) | Haemoglobin count to define anaemia | Below 13 g/dL6 |
The guideline values and the units provided in this table are for your reference only and it is possible that your doctor uses different guideline values or units. Talk to your doctor about what your results mean.
Your doctor may also test your blood for iron deficiency either as part of the first blood test, or in a follow-up test. Several different results from your blood test can help a doctor to understand whether or not you are iron deficient. These include:
- TSAT, or transferrin saturation, a test to measure the amount of iron that is being transported in your body7
- Serum ferritin, which indicates the amount of iron stores you have in your body8
The table beneath shows the values that may be used by your doctor to determine if you are iron deficient.
| Blood Test Result | Guideline Values your Doctor may use when Checking for Anaemia |
|---|---|
| Serum Ferritin | <30 ng/mL (patients in remission of IBD) |
| Ferritin | <100 ng/mL (patients with IBD active disease) |
| Transferrin saturation (TSAT) | <20% |
The guideline values and the units provided in this table are for your reference only and it is possible that your doctor uses different guideline values or units. Talk to your doctor about what your results mean.
Depending on the results of your blood tests, your doctor may diagnose you as being iron deficient or as having iron deficiency anaemia. They may also discuss treatment options with you.
Treatment options for iron deficiency in IBD
Once your doctor has understood your symptoms and looked at the results of your blood tests they will be able to confirm if you are iron deficient or have iron deficiency anaemia, and recommend the best treatment for you.
One treatment option may be to increase the amount of iron in your diet by eating more iron-rich foods like red meat, liver, enriched cereals and leafy greens9. When planning meals, this guide may help you choose food that is rich in iron. Talk to your doctor if you are planning on changing your diet as you may need to consider whether certain iron-rich foods might increase the symptoms of your IBD. For example, it may be best for you to avoid some beans, legumes and fibre-rich foods like broccoli if you are currently experiencing a flare-up of your IBD. When your IBD is in remission, however, you will likely be able to eat many iron-rich foods so you can maintain your iron stores.
Although dietary sources can help you to maintain good iron levels, if you are anaemic you may also have to be given extra iron. Your doctor may give you extra iron in the form of:
- Oral iron supplements, available over the counter or on prescription10
- Intravenous iron, where iron is delivered directly into your blood stream through a vein, for example through ‘a drip’ or an injection10
- A blood transfusion, if your iron levels are extremely low11
Some treatments may be more suitable for you than others, depending on your level of iron deficiency, how your IBD is at the time and what other medications you are on. Your doctor will be able to discuss the treatment options available to you and advise you on the most suitable treatment option for your condition.
It may take dierent lengths of time for you to feel better, depending on the treatment. It is best to find out from your doctor when you can expect to notice a positive effect12. If you are having problems with your treatment and experiencing side effects,or finding that your symptoms are not improving, go to see your doctor again for advice.
- NIH Senior Health talking to your doctor. Available at: http://nihseniorhealth.gov/talkingwithyourdoctor/planningyourdoctorvisit....
- NHS Choices GP Choice. Available at: http://www.nhs.uk/choiceintheNHS/Yourchoices/GPchoice/Pages/GPappointmen....
- Gasche C, Lomer MCE, Cavill I, Weiss G. Iron, anaemia, and inflammatory bowel diseases. Gut. 2004;53(8):1190-7. doi:10.1136/gut.2003.035758.
- Wood MM, Elwood PC. Symptoms of iron deficiency anaemia: A community survey. Br J Prev Soc Med. 1966;20:117-121.
- Dean L. 1. Blood and the cells it contains. Blood Groups Red Cell Antigens. 2005:1-6.
- Sullivan KM, Mei Z, Grummer-Strawn L, Parvanta I. Haemoglobin adjustments to define anaemia. Trop Med Int Health. 2008;13(10):1267-71. doi:10.1111/j.1365-3156.2008.02143.x.
- Seid MH, Derman RJ, Baker JB, Banach W, Goldberg C, Rogers R. Ferric carboxymaltose injection in the treatment of postpartum iron deficiency anemia: a randomized controlled clinical trial. Am J Obstet Gynecol. 2008;199(4):435.e1-7. doi:10.1016/j.ajog.2008.07.046.
- Suominen P, Punnonen K, Rajamäki a, Irjala K. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood. 1998;92(8):2934-9.
- Michael Alleyne, McDonald K. Horne, MDb, and Jeffery L. Miller M. Individualized treatment for iron deficiency anemia in adults. Am J Med. 2008;121(11):943-948. doi:10.1016/j.amjmed.2008.07.012.Individualized.
- Stein J, Hartmann F, Dignass AU. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol. 2010;7(11):599-610. doi:10.1038/nrgastro.2010.151.
- Gomollón F, Gisbert JP. Current Management of Iron Deficiency Anemia in Inflammatory Bowel Diseases: A Practical Guide. Drugs. 2013;73(16):1761-70.
- Goddard AF, James MW, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10):1309-16. doi:10.1136/gut.2010.228874.