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Intravenous iron in inflammatory bowel disease

World Journal of Gastroenterology 2009年第37期15卷 4666-4674页

作者： Manuel Muoz Susana Gómez-Ramírez José Antonio García-Erce Transfusion Medicine School of Medicine University of Málaga Málaga 29071 Spain Department of Internal Medicine University Hospital Virgen de la Victoria Málaga 29010 Spain Department of Hematology and Hemoterapy University Hospital Miguel Servet Zaragoza 50008 Spain

The prevalence of anemia across studies on patients with inflammatory bowel disease (IBD) is high (30%). Both iron defi ciency (ID) and anemia of chronic disease contribute most to the development of anemia in IBD. The prevalence of ID is even higher (45%). Anemia and ID negatively impact the patient's quality of life. Therefore, together with an adequate control of disease activity, iron replacement therapy should start as soon as anemia or ID is detected to attain a normal hemoglobin (Hb) and iron status. Many patients will respond to oral iron, but compliance may be poor, whereas intravenous (IV) compounds are safe, provide a faster Hb increase and iron store repletion, and presents a lower rate of treatment discontinuation. Absolute indications for IV iron treatment should include severe anemia, intolerance or inappropriate response to oral iron, severe intestinal disease activity, or use of an erythropoietic stimulating agent. Four different products are principally used in clinical practice, which differ in their pharmacokinetic properties and safety profi les: iron gluconate and iron sucrose (lower single doses), and iron dextran and ferric carboxymaltose (higher single doses). After the initial resolution of anemia and the repletion of iron stores, the patient's hematological and iron parameters should be carefully and periodically monitored, and maintenance iron treatment should be provided as required. New IV preparations that allow for giving 1000-1500 mg in a single session, thus facilitating patient management,provide an excellent tool to prevent or treat anemia and ID in this patient population, which in turn avoids allogeneic blood transfusion and improves their quality of life.

关键词： Inflammatory bowel disease Anemia iron deficiency functional iron deficiency Erythropoiesisstimulating agents Oral iron Intravenous iron

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