Thrombosis and Anemia in Pediatric Inflammatory Bowel Disease: Pathophysiology, Clinical Impact and Future Directions

Pediatric inflammatory bowel disease (PIBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is associated with inflammation that extends beyond the gastrointestinal tract. Among the most significant extraintestinal complications are anemia and thrombosis, both of which can impact disease severity, quality of life, and long-term outcomes. This review aims to explore the intertwined pathophysiology of anemia and thrombosis, clinical implications of these two complications, and management strategies for anemia and thrombosis in PIBD. Anemia is the most common systemic complication in PIBD, with multifactorial etiologies, including iron deficiency, chronic inflammation, and nutritional deficiencies. Despite its high prevalence, it remains underdiagnosed and undertreated. Thrombosis, although less frequent, poses significant risk, particularly during disease flares, hospitalizations, and in the presence of central venous catheters or corticosteroid therapy. The proinflammatory and hypercoagulable state in inflammatory bowel disease (IBD) increases thrombotic risk, necessitating early identification and, in high-risk cases, consideration of thromboprophylaxis. Anemia and thrombosis represent significant yet often overlooked complications in PIBD. Proactive screening, individualized risk stratification, and integrated management approaches are critical to improving outcomes. Further pediatric-specific research is needed to develop tailored prevention and treatment strategies.