Anemia in inflammatory bowel diseases: the approaches to its diagnosis, treatment and prevention

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Abstract

Anemia is a frequent systemic complication and extra-intestinal manifestation of inflammatory bowel diseases (IBD). Despite significant progress in IBD treatment, late diagnosis and insufficient correction of concomitant anemia remain a problem in routine clinical practice. The review describes the main pathophysiological mechanisms of IBD-associated anemia, such as iron deficiency, chronic inflammation (anemia of chronic disease) and B9 and B12 deficiencies. The authors highlight the main diagnostic principles of these conditions, present the strategy for their differential diagnosis, describe the state-of-theart approaches to the correction of iron-deficient anemia in IBD, and delineate the role of oral and parenteral medications for replacement therapy. Optimal treatment goals and prevention methods of an iron-deficient condition are given. Special attention is focused on the principles on red cell mass transfusions in acute massive blood loss. The authors describe the main differentiating features of anemia of chronic disease and its treatment in IBD patients with various grades of the inflammation. The paper contains the indications and treatment regimens for B12 and foliate-deficient anemia with consideration of the IBD course. The authors of the article are members of the Working Group of the Russian Society on the study of IBD and believe that the literature analysis performed would allow for its use to issue the Russian clinical guidelines on the management of patients with anemia in ulcerative colitis and Crohn's disease.

About the authors

I. V. Gubonina

Military Medical Academy named after S.M. Kirov

Author for correspondence.
Email: giv70@bk.ru
ORCID iD: 0000-0002-6302-7767

Irina V. Gubonina – MD, PhD, Associate Professor, Chair of Therapy No. 2 (Postgraduate Training)

6А Akademika Lebedeva ul., Saint Petersburg, 194044, Russian Federation

Russian Federation

O. B. Shchukina

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: burmao@gmail.com

Oksana B. Shchukina – MD, PhD, Head of the Municipal Center for Diagnostics and Treatment of Inflammatory Bowel Diseases, Municipal Clinical Hospital No. 3; Associate Professor, Chair of Family Medicine 

6–8 L'va Tolstogo ul., Saint Petersburg, 197022, Russian Federation 

Russian Federation

N. I. Stuklov

Peoples' Friendship University of Russia (RUDN University)

Email: stuklovn@gmail.com
ORCID iD: 0000-0002-4546-1578

Nikolai I. Stuklov – MD, PhD, Professor, Chair of Hospital Therapy with Courses of Endocrinology, Hematology and Clinical Laboratory Diagnostics, Medical Institute

6 Miklukho-Maklaya ul., Moscow, 117198, Russian Federation 

 

Russian Federation

T. V. Gaponova

National Research Center for Hematology

Email: gentech@nm.ru
ORCID iD: 0000-0002-9684-5045

Tatiana V. Gaponova – MD, PhD, Deputy Director, Head of Transfusion Service

4 Novyy Zykovskiy proezd, Moscow, 125167, Russian Federation

ResearcherID: M-6017-2014.

Russian Federation

D. I. Abdulganieva

Republican Clinical Hospital, Department of Health of the Republic of Tatarstan;
Kazan State Medical University

Email: diana_s@mail.ru
ORCID iD: 0000-0001-7069-2725

Diana I. Abdulganieva – MD, PhD, Professor, Chief of the Therapeutic Clinic, Republican Clinical Hospital; Head of the Chair of Hospital Therapy, Kazan State Medical University

138 Orenburgskiy trakt, Kazan, 420064; 49 Butlerova ul., Kazan, 420012, Russian Federation

Russian Federation

O. V. Knyazev

Loginov Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: o.knyazev@mknc.ru

Oleg V. Knyazev – MD, PhD, Head of the Department of Inflammatory Bowel Diseases

86 Shosse Entuziastov, Moscow, 111123, Russian Federation

Russian Federation

N. S. Gubonina

Almazov National Medical Research Centre

Email: fake@neicon.ru

Nadezhda S. Gubonina – MD, Clinical Ordinator, Chair of Internal Diseases

2 Akkuratova ul., Saint Petersburg, 197341, Russian Federation

Russian Federation

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Copyright (c) 2019 Gubonina I.V., Shchukina O.B., Stuklov N.I., Gaponova T.V., Abdulganieva D.I., Knyazev O.V., Gubonina N.S.

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