The ABC of IBD: “A” is for Anemia

Many people with IBD have a hard time conveying that their disease is more than just “a bathroom disease” (whatever that may mean). While digestion and its products certainly do play a big part, they are a fraction of everything that happens to you in the grand scheme of things. So, my newest project is to go through the alphabet and explain symptoms, medications, procedures- things that have to do with IBD. I’ll give you a brief definition and tell you stories about my rock star life with IBD. For every letter, there are several entries that I could make. Why pick “Anemia” over “Aminosalicylates” or “Anal fissure”? I think of what could be interesting to readers, newly diagnosed patients, other patients who would like to share their experiences, and, ultimately something I can speak about. And, perhaps, I’ll go several rounds, who knows!

So, Anemia. The broadest definition that I could find was “abnormally low levels of healthy red blood cells or of hemoglobin (the component that carries oxygen).” (1) So where does IBD come in here? These low levels of erythrocytes (the red blood cells) and the hemoglobin means that your blood can’t carry oxygen as fast as it should through your body.

Broadly speaking, there are three underlying causes of anemia. “Increased breakdown of red blood cells”- this can be caused by genetic disorders such as sickle cell anemia, or thalassemia. (2) Then there is anemia due to blood loss- such as trauma and gastrointestinal bleeding- as happens in IBD. The third form of anemia is sometimes also called iron-deficiency anemia, or anemia due to decreased red blood cell production. To produce red blood cells, the body needs the mineral iron (among other things). If you have trouble absorbing vitamins and nutrients due to a constant inflammation in your gastro-intestinal tract (or because it has been partially or completely removed) you will most likely have an iron deficiency.

With IBD, the second and the third form of anemia will be the most common, and that’s why your GI will not only check the red and white blood cell count, but also your hemoglobin levels.  Ironically, some of the medication that we get for IBD, like azathioprine and methotextrate can also cause iron deficiency (3), so really people, go and get your blood taken on a regular basis.

The symptoms are diverse and can range from tiredness, headaches, shortness of breath (fairly common) to mouth ulcers and “the desire to eat not food items, such as ice, paper or clay” (4). With the exception of the last one, I have had all of the above. Unfortunately, these symptoms are also rather vague and can be associated with a number of things. So, let me repeat myself, get a blood test. Most people will have anemia at some point in their life- heavy periods, pregnancy,  one sided diets, or even endurance training can lead to anemia. It is still not trivial. Anemia in children for example, can slow down brain development, or cause behavioral problems. For most people, and adjustment in diet can already work wonders. Foods high in iron include leafy greens, dried fruits, beans and nuts, red meat, poultry. (5) If you have IBD and your inflamed gut can’t absorb these lovely food items, then the next item, iron pills won’t help so much either. I always get horrible stomach cramps from them. For a while I took a mix of folate, iron and vitamin B12, and that helped a bit. Iron transfusions are another possibility. These are often used when a patient already has severe anemia, and getting the iron levels back to normal would take a long time with supplements. (6) I have had several of them- mine took about four hours each.

Obviously, the treatment of your anemia will go hand in hand with the overall treatment of your IBD- you’ll get medication to deal with your inflammation, you’ll get medications to deal with your pain etc. Yet, iron deficiency, and anemia (whether it is caused by internal bleeding or iron deficiency) can be an early detector that something is wrong. So, I will sound like a broken record, but go and get your blood tested regularly.

Sources:

(1) UCB “A word or two about Crohn’s Disease: A Handy Reference Guide for Patients and Families”, p.1

(2) National Heart, Lung and Blood Institute: “What is anemia?” https://www.nhlbi.nih.gov/health/health-topics/topics/anemia

(3) Warner, Andrew; Barto, Amy. “100 Questions & Answers about Crohn’s Disease and Uclerative Colitis: A Lahey Guide.” Jones and Bartlett, Sudbury: 2007. P.152-3.

(4) NHS: Iron Deficiency Anemia: http://www.nhs.uk/conditions/Anaemia-iron-deficiency-/Pages/Introduction.aspx

(5) Mayo Clinic: Iron Deficiency Anemia: Prevention. http://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/basics/prevention/con-20019327

(6) Cleveland Clinic: Intravenous Iron Supplementation. http://my.clevelandclinic.org/health/diseases_conditions/hic_Anemia/hic_intravenous_iron_supplementation