Clinical Pathway for Evaluation and Treatment of Iron Deficiency and Anemia in Patients with Inflammatory Bowel Disease (IBD)

Goals and Metrics
Patient Education
  • ID: Iron deficiency
  • IDA: Iron deficiency anemia
  • Hb: Hemoglobin
  • TSAT: Transferrin saturation
CHOP Hemoglobin Normal Values
Age (years) Hb (g/dL)
  Male Female
6 mos - 2 10.5 - 13.5
2-6 11.5 - 13.5
6-12 11.5 - 15.5
12-18 13.0 - 16.0 12.0 - 16.0
> 18 13.5 - 17.5 12.0 - 16.0
Iron Deficiency in Relation to Disease Activity
Inactive IBD Ferritin < 30 ug/L
Active IBD Ferritin < 100 ug/L and TSAT < 20%
Management of Iron Deficiency and Anemia in Patients with Inflammatory Bowel Disease (IBD)
 
 
Universal Screening for Iron Deficiency and Anemia
  • Order: CBC
    • Ferritin
    • TSAT
    • Reticulocyte count
 
 
Assess for anemia (refer to CHOP Hb normal values)
Assess for Iron Deficiencyin Relation to Disease Activity
 
 
 
 
 
 
 
 
No anemia
and
adequate iron store
Anemia
with
adequate iron store
Iron deficiency
without
anemia
Iron deficiency
with
anemia
 
 
 
 
 
 
 
 
Universal Screening
Inactive IBD Every 6 months
Active IBD Every 3 months
Universal Screening
Evaluate for Other Causes of Anemia
  • Determine route of iron therapy based on:
    • Disease activity
    • Anemia severity
 
 
Assess Disease Activity
 
 
 
 
Active IBD
Inactive IBD
 
 
 
 
Assess severity of anemia
(Refer to WHO anemia severity range)
 
 
 
 
Moderate or severe IDA
Mild or non-anemic ID
 
 
 
 
IV Iron Therapy
Oral Iron Therapy
 
 
 
 
Assess Response in Anemic Patients
Repeat CBC and Reticulocyte Count in 4 Weeks
 
 
Achievement of Therapeutic Goals of Iron Therapy
Normalization of Hb by 4-8 weeks
And
Normalization of iron store
 
 
Prevention of Recurrent Iron Deficiency and Anemia
Repeat CBC, ferritin, TSAT, reticulocyte count, every 3 months
for at least a year after correction
WHO Anemia Severity Range (g/dL)
  Mild Moderate Severe
< 5 < 11 < 10 < 7
≥ 5 < 11.5 < 11 < 8
12-14 < 12 < 11 < 8
≥ 15 (F) < 12 (M) < 13 < 11 < 8
Posted: November 2018
Revised: August 2022
Authors: J. Breton, MD; A. B. Grossman, MD; C. Witmer, MD; J. Scaramuzzi, RN; J. McDermott, RN; N. Stoner, RD;
C. Law, PharmD; M. Downing, MHA