Abstract :Objectives: Iron deficiency anemia (IDA) frequently complicates inflammatory bowel disease
(IBD) in children and adults. Oral iron may exacerbate gastrointestinal symptoms and absorption
may be insufficient in intestinal inflammation. Even where oral iron is successful, repletion of iron
stores can be unacceptably slow. Intravenous (IV) iron compounds were in the past associated with
serious adverse reactions and historically were considered a last resort in children. New generation
preparations have a safer profile in adults although reluctance to use them in children may persist,
where safety data is lacking. We investigate the safety and efficacy of ferric carboxymaltose (FCM)
and iron sucrose (IS) in children.
Methods: We retrospectively identified all children with IBD who received parenteral iron over
a 38 month period in a single regional referral centre. Safety, tolerability and adverse events were
established by case note review. Efficacy was assessed by change in hematinic indices pre- and posttreatment.
Results: 47 children (18 male; median age 14yrs, range 3-17) received a total of 104 iron infusions.
44% (21) had Crohn’s disease (CD); 56% (27) ulcerative colitis (UC). 40 received FC, eight IS
and one both. Three children developed mild rash post infusion which resolved quickly with
chlorphenamine. Mean increase in hemoglobin (Hb) was 2.5g/dl (0.3-5.8). Iron levels increased by
a mean of 8.4 g/dl (1-25), transfer in saturation by 16.2% (2-47). Transfer in decreased by 0.84 g/dl
(0.3-3.4).
Conclusion: New generation parenteral iron preparations are safe, well tolerated and efficacious in
children with IDA and IBD.
What is known: Iron deficiency anemia (IDA) is a common complication of inflammatory bowel
disease (IBD) and a significant contributor to morbidity.
IDA should be actively treated in IBD.
Parenteral iron is effective and relatively safe in adults.
What is new: The intravenous iron preparations ferric carboxymaltose (FCM) and iron sucrose
(IS) are effective treatments for IDA in children with IBD. The safety profiles of FCM and IS are
favourable, and similar in children to that in adults.