Anemia in Children With Inflammatory Bowel Disease: A Position Paper by the IBD Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition

J Pediatr Gastroenterol Nutr. 2020 Oct;71(4):563-582. doi: 10.1097/MPG.0000000000002885.

Alka Goyal 1 2, Yuhua Zheng 3, Lindsey G Albenberg 4, Natalie L Stoner 4, Lara Hart 5, Razan Alkhouri 6, Kyle Hampson 1 7, Sabina Ali 8, Michele Cho-Dorado 9, Rakesh K Goyal 1, Andrew Grossman 4


Author information

  • 1UMKC School of Medicine, Children's Mercy Kansas City, Kansas City, MO.
  • 2Stanford University School of Medicine and the Lucile Packard Children's Hospital, Palo Alto, CA.
  • 3Pancreas Program, GI International Education Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA.
  • 4Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA.
  • 5Division of Pediatric Gastroenterology, McGill University, Montreal, Quebec, Canada.
  • 6University of New Mexico, Albuquerque, NM.
  • 7Department of Pharmacology, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY.
  • 8University of California San Francisco, Benioff Children's Hospital Oakland, Oakland, CA.
  • 9Advocade Children's Hospital, Park Ridge, IL.


Anemia is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). It can be asymptomatic or associated with nonspecific symptoms, such as irritability, headaches, fatigue, dizziness, and anorexia. In IBD patients, the etiology of anemia is often multifactorial. Various causes include iron deficiency, anemia of inflammation and chronic disease, vitamin deficiencies, hemolysis, or myelosuppressive effect of drugs. Anemia and iron deficiency in these patients may be underestimated because of their insidious onset, lack of standardized screening practices, and possibly underappreciation that treatment of anemia is also required when treating IBD. Practitioners may hesitate to use oral preparations because of their intolerance whereas intravenous preparations are underutilized because of fear of adverse events, availability, and cost. Several publications in recent years have documented the safety and comparative efficacy of various intravenous preparations. This article reviews management of anemia in children with IBD, including diagnosis, etiopathogenesis, evaluation of a patient, protocol to screen and monitor patients for early detection and response to therapy, treatment including parenteral iron therapy, and newer approaches in management of anemia of chronic disease. This report has been compiled by a group of pediatric gastroenterologists serving on the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) IBD committee, in collaboration with a pediatric hematologist, pharmacist, and a registered dietician who specializes in pediatric IBD (IBD Anemia Working Group), after an extensive review of the current literature. The purpose of this review is to raise awareness of under-diagnosis of anemia in children with IBD and make recommendations for screening, testing, and treatment in this population.

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