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Treatment targeting pediatric inflammatory bowel disease-associated anemia: experience from a single tertiary center

Ana Sc Fernandes1,2, Sara Azevedo1,2, Ana Rita Martins1

  • 1Pediatric Department, University Hospital Santa Maria, Lisbon Medical Centre, Lisbon, Portugal.

Clinical and Experimental Pediatrics
|June 12, 2025
PubMed

Insights

Iron deficiency (ID) and iron deficiency anemia (IDA) are common in pediatric inflammatory bowel disease (IBD). Intravenous iron sucrose (IS) and ferric carboxymaltose (FCM) are safe and effective treatments, but ID often recurs, necessitating proactive management.

Area of Science:

  • Pediatric Gastroenterology
  • Hematology
  • Internal Medicine

Background:

  • Iron deficiency (ID) and iron deficiency anemia (IDA) are frequent complications in pediatric inflammatory bowel disease (IBD).
  • These conditions are often overlooked and undertreated due to uncertainties in optimal iron formulation, dosage, administration route, and safety.
  • Undertreatment negatively impacts pediatric patient development and quality of life.

Purpose of the Study:

  • To evaluate the safety and efficacy of iron sucrose (IS) and ferric carboxymaltose (FCM) for treating ID and IDA in pediatric IBD patients.
  • To compare the outcomes of IS and FCM in this specific patient population.

Main Methods:

  • Retrospective review of medical records for pediatric IBD patients treated with IS (age < 14) or FCM (age ≥ 14) over 10 years.
  • Iron doses calculated using the Ganzoni formula; adverse reactions monitored during and after treatment.
  • Efficacy defined by hemoglobin increase (≥2 g/dL) or anemia resolution within 12 weeks for IDA, and transferrin saturation or ferritin normalization for ID.

Main Results:

  • Sixty-three patients received IV iron (104 treatment courses: 63 FCM, 41 IS).
  • Treatment efficacy was 66.7% for FCM and 67.6% for IS in IDA patients; 77.8% for ID without anemia.
  • Recurrent ID required retreatment in 41.3% of patients; only one adverse reaction (hypotension and rash) noted with IS.

Conclusions:

  • Ferric carboxymaltose (FCM) and iron sucrose (IS) are safe and effective for correcting iron deficiency in pediatric IBD patients.
  • Iron deficiency frequently recurs in this population, highlighting the importance of proactive screening and management.
  • This study provides valuable data from a large, long-term follow-up cohort on IV iron use in pediatric IBD.
Abstract

Keywords:
AnemiaFerric carboxymaltoseIron deficiencyIron sucrosePediatric inflammatory bowel disease

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