Introduction: Iron deficiency anemia (IDA) is the most prevalent extra-intestinal sequelae of pediatric inflammatory bowel disease. As IV iron therapy options expand, use of oral iron supplementation (oral Fe) to treat IDA in the presence of increased ulcerative colitis (UC) disease activity is low due to beliefs of low bioavailability and effectiveness. The purpose of this study is to evaluate the effectiveness of oral Fe in anemic pediatric UC patients after hospitalization for disease flare. Methods: We performed a longitudinal cohort analysis of pediatric patients (≤ 21 years of age) admitted to a single tertiary care academic hospital for the management of active UC (ICD-9 556.xx; ICD-10 56.x) between 2003 and 2015. We defined anemia as a hemoglobin (Hgb) value at or below the lower 2.5 percentile for age and gender, based on the NHANES distribution. Among anemic patients, we used longitudinal regression to evaluate the hgb response to oral Fe prescribed at hospital discharge. Results: We identified 193 hospitalized pediatric UC patients with hgb values at the time of discharge. Of these, 109 patients (56%) were anemic at the time of hospital discharge. Only 36 (33%) of anemic patients were prescribed oral Fe. Univariate analysis showed no difference between the genders or age with respect to anemia status. After adjustment for C-RP level at discharge, patients receiving oral Fe demonstrated an increase of 2.0 gm/dL (95% CI 1.4, 2.6) at 1-month follow-up visit as compared to 0.3 gm/dL (95% CI -0.1, 0.7) in those not prescribed oral Fe (p<0.0001) (Figure 1). Conclusion: Oral Fe is an effective treatment strategy for children with anemia in the setting of a UC flare. Nevertheless, this safe and effective treatment is under-utilized and should be considered as first-line iron replacement therapy. We believe the recognition and treatment of anemia is a prime target for education and quality improvement.
