Anemia is one of the most common extraintestinal manifestations of IBD, affecting up to two-thirds of patients. The condition occurs when levels of red blood cells or hemoglobin concentration within the red blood cells are lower than normal. Iron is required to make hemoglobin, which is responsible for carrying oxygen throughout the body.
A lack of oxygen-rich blood results in feeling weak and tired. Although these symptoms are relatively mild, anemia can still greatly impair the quality of life in IBD patients.
Types of Anemia Associated with IBD
The most common types of anemia in IBD is Iron Deficiency Anemia (IDA), Anemia of Chronic Disease (ACD), or a combination of both.
Iron Deficiency Anemia (IDA)
IDA may result from a lack of iron-rich foods, but in IBD it can occur from chronic blood loss and inflammation caused by intestinal mucosal damage. This damage lowers the capacity of intestinal absorptive cells to absorb iron, which consequently becomes trapped in the macrophages (a type of white blood cell). The supply of iron to hemoglobin synthesis becomes limited, resulting in anemia. Treating IDA generally involves increasing iron-rich foods in your diet, or the use of iron supplements.
Anemia of Chronic Disease (ACD)
ACD can be caused by low levels of iron in the blood, even if there are normal iron levels in your body tissue. This may occur when the kidney produces less EPO (a hormone that signals to your marrow to make fewer red blood cells). In this case, the bone marrow doesn’t respond appropriately to EPO and produces fewer red blood cells than needed.
The release of systemic inflammatory cytokines (e.g. interleukin 6) from the inflamed intestine is also at play here. This triggers increased hepcidin hepatic synthesis, which potentially may decrease the duodenal (the first part of the small intestine) absorption of iron.
The Connection Between IBD & Anemia
Those with IBD are at high risk for anemia due to a number of factors:
- Poor intestinal absorption of minerals, vitamins, and nutrients (e.g. iron, folate, vB12) caused by inflammation or diarrhea.
- Continual or recurrent intestinal blood loss
- Systemic iron sequestration driving a negative iron balance
Ulcerative Colitis & Anemia
Those with moderate active UC have a higher prevalence of anemia than patients in remission, likely due to more blood loss. Therefore it is highly recommended to screen for anemia during a flare-up, especially with active disease.
Crohn’s Disease & Anemia
In Crohn’s disease patients, anemia generally occurs as a result of bleeding in the digestive tract. This loss of blood occurs slowly over long periods of time, and may not show overt symptoms. There may be bleeding from a rupture of blood vessels in the digestive tract caused by ulcers and fissures penetrating the inner mucosal layer.
Signs & Symptoms of Anemia
Signs of anemia vary depending on the severity of the condition. Key symptoms to look out for are labored breathing and a rapid heart rate. That said, in some cases, there may be no signs or symptoms, which is why it’s so important to get screened for anemia if you have IBD.
Symptoms of anemia include:
- Lethargy, fatigue, or feeling weak
- Dizziness or lightheadedness
- Cold or numb hands and/or feet
- Shortness of breath
- Pale skin
- Chest pain (rare)
- Palpitation, hypotension, rapid heartbeat
Treatment for Anemia & Ulcerative Colitis
Depending on the severity of anemia and how active your disease is, your doctor, nutritionist or dietician may recommend one or more of the following treatments.
If you are in remission and can tolerate foods rich in iron, this may be a helpful option for you.
Sources of iron include:
- Nuts & Seeds
Oral iron supplements should only be taken if you’re in remission, as they could potentially exasperate inflammation in the digestive tract and worsen symptoms of Crohn’s disease or ulcerative colitis.
Iron supplements may cause digestive issues like cramping, diarrhea, nausea, or constipation, even for those already in remission. That said, these supplements differ and some may be better tolerated than others. Ask your doctor about the right product and dose for you and your condition.
If you have UC, your doctor may also recommend other supplements such as vitamin B12 and folic acid to counter poor vitamin and mineral absorption.
Your doctor may recommend delivering iron through IV, which bypasses the digestive tract. This is a good option for those with IBD, as it does not cause the same digestive side effects as oral supplements. According to the research, IV iron supplementation is the more effective treatment for anemia for those with active IBD.
Severe cases of anemia may require a blood transfusion. This will involve an IV line into a blood vessel to deliver healthy blood that matches your blood type. A blood transfusion will help raise oxygen and hemoglobin levels. Typically, this can take 1-4 hours.
For many extra-intestinal manifestations of Colitis, the best course of treatment is through the management of the underlying inflammatory bowel condition. This may involve standard medications for UC such as aminosalicylates, corticosteroids, immunomodulators, or biologics.
Many use diet to manage UC. Working with a registered dietician can help you avoid foods that aggravate your digestive system. While there is not much research to support diet as a sole therapy for UC, recent clinical trials have shown great results for diet as a therapy for Crohn’s disease, especially in children.
For those looking for a fast, natural therapy for the UC, Qing Dai and Curcumin supplements have been found highly effective in inducing and maintaining remission as they are both potent antioxidants and highly anti-inflammatory.
When to see a doctor
You should alert your doctor if you see any change in your symptoms, especially a worsening of bleeding, a decrease in your energy levels, an inability to focus, or if something just feels off.
If it’s been over 6 months since your last blood test, it’s recommended to check your iron levels. Keep in mind that anemia symptoms are not always noticeable, or there may be no symptoms at all. Still, it’s important to check your iron levels regularly, especially when also managing an inflammatory bowel disease.