Inflammatory bowel disease anemia

Noninfectious causes of acute diarrhea include drugs and toxins (Table 18-3), laxative abuse, food intolerance, irritable bowel syndrome (IBS), inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple s disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue. 

The following "red flag" or alarm features are not associated with IBS and may indicate inflammatory bowel disease, cancer, or other disorders fever, weight loss, bleeding, and anemia, which may be accompanied by persistent severe pain. 

Since there is no true excretion of iron from the body, iron-deficiency anemia occurs mostly because of inadequate absorption of iron or excess blood loss. Inadequate absorption may occur in patients who have congenital or acquired intestinal diseases, such as inflammatory bowel disease, celiac disease, or bowel resection. Achlorhydria and diets poor in iron also may contribute to poor absorption of iron. In contrast, iron deficiency also may occur in patients who exhibit a higher rate of iron loss from the body. This is manifested in... 

Parenteral therapy should be reserved for patients with documented iron deficiency who are unable to tolerate or absorb oral iron and for patients with extensive chronic anemia who cannot be maintained with oral iron alone. This includes patients with advanced chronic renal disease requiring hemodialysis and treatment with erythropoietin, various postgastrectomy conditions and previous small bowel resection, inflammatory bowel disease involving the proximal small bowel, and malabsorption syndromes. 

The most common causes of vitamin B12 deficiency are pernicious anemia, partial or total gastrectomy, and conditions that affect the distal ileum, such as malabsorption syndromes, inflammatory bowel disease, or small bowel resection. 

At higher dosage, methotrexate may cause bone marrow depression, megaloblastic anemia, alopecia, and mucositis. At the doses used in the treatment of inflammatory bowel disease, these events are uncommon but warrant dose reduction if they do occur. Folate supplementation reduces the risk of these events without impairing the antiinflammatory action. 

Other Conditions. Other groups of individuals are considered to be at risk either from a marginal dietary deficiency or from an acquired deficiency secondary to disease. These groups would include female adolescents during pregnancy and lactation. Also affected may be patients with malabsorption syndrome, inflammatory bowel disease, alcoholic liver disease, and anorexia nervosa. A significant proportion of cases of sickle cell anemia have clinical signs and symptoms and some laboratory abnormalities of zinc deficiency. These patients respond well to zinc supplementation. ... 

Malnutrition has been reported in 20% to 45% of patients with inflammatory bowel disease (IBD). Malabsorption, increased gastrointestinal losses, or poor oral intake are the predominant causes. " Decreased food intake may be due to pain, anorexia, or altered taste malabsorption may be due to mucosal abnormalities, bacterial overgrowth, or diminished absorptive surface area after surgical resection of diseased bowel, and hypermetabolism may be a consequence of fever and infection. Various nutrient abnormalities, such as anemia... 

The incidence and severity of Salmonellosis is increased in the following conditions or comorbidities. Achlorhydria, pernicious anemia, impaired immune response, HIV infection, malnutrition, chronic steroid administration, frequent administration of antibiotics which affects intestinal flora and lowers resistance of colonization, lymphoproliferative diseases, malignant tumors, schistosomiasis, chronic hemolytic syndromes (sickle cell disease), malaria and inflammatory bowel disease, mainly ulcerative cohtis. 

Aplastic anemias (some forms) Complications of malignancy Hypercalcemia Hematologic malignancies Acute lymphoblastic leukemia Lymphomas Multiple myeloma Immune hemolytic anemia Immune thrombocytopenia Inflammatory bowel disease Transfusion reactions Allergic and Immune Diseases Acute hypersensitivity reactions Allergic rhinitis Anaphylaxis... 

Halpin, T. C., Bertino, J. S., Rothstein, F. C., Kurczinski, E. M., and Reed, M. C., 1982, Iron deficiency anemia in childhood inflammatory bowel disease Treatment with intravenous iron dextran, J. Parent. Enter. Nutr. 6 9. 

Control of anemia with darbepoetin alfa has been reported in association with cancer chemotherapy, treatment of renal insufficiency, to control anemia due to inflammatory bowel disease, and in diabetes-induced anemia. However, this appears to be the first time it has been used successfully to control a drug-induced anemia. 

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