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THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 1 | 17 REVIEW inactive and who have not been previously intolerant to oral iron. Worsening of IBD activity, however, has been observed with oral iron formulations. Red blood cell transfusions may be considered when the Hb is below 7 g/dl or higher, if the patient is symptomatic or has particular risk factors e.g. coronary heart disease. Blood transfusions should always be followed by subsequent i.v. iron supplements. Deficiencies of vitamin B12 and folate should be treated to avoid anaemia 6 . Management of NIDA in IBD should always involve the diagnosis and treatment of other possible concomitant diseases such as infections, malignancies, and side effects of medications 6 . Thiopurines rarely cause isolated anaemia, but if other causes of anaemia have been excluded, the dose should be adjusted, or the discontinuation of therapy should be considered. In the case of anaemia of chronic diseases, treatment of IBD should be optimised in combination with anaemia specific treatment. If there is an insufficient response to i.v. iron in these patients, then an erythropoietin stimulating agent may be considered and the target Hb level should not be above 12 g/dl 6 . In conclusion, as iron deficiency anaemia is the most common complication of IBD, ID and IDA should be routinely screened for and treated in IBD patients. i.v. iron normalises haemoglobin and replenishes iron stores in IBD patients efficiently and safely. The ECCO consensus guidelines should be used to provide clinical advice in your daily practice, to improve your knowledge and understanding of IBD and to improve the standard of care for your patients. References 1. Resál, T., Farkas, K. & Molnár, T. Iron Deficiency Anemia in Inflammatory Bowel Disease: What Do We Know? Front. Med. 8, (2021). 2. WHO & Chan, M. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switz. World Heal. Organ. 1–6 (2011). 3. Koutroubakis, I. E. et al. Five-Year Period Prevalence and Characteristics of Anemia in a Large US Inflammatory Bowel Disease Cohort. J. Clin. Gastroenterol. 50, 638–643 (2016). 4. Burisch, J. et al. Occurrence of anaemia in the first year of inflammatory bowel disease in a European population-based inception cohort-An ECCO-EpiCom study. J. Crohn’s Colitis 11, 1213–1222 (2017). 5. Bager, P. et al. The prevalence of anemia and iron deficiency in IBD outpatients in Scandinavia. Scand. J. Gastroenterol. 46, 304–309 (2011). 6. Dignass, A. U. et al. European Consensus on the Diagnosis and Management of Iron Deficiency and Anaemia in Inflammatory Bowel Diseases. J. Crohn’s Colitis 211–222 (2015) doi:10.1093/ ecco-jcc/jju009. 7. Bruner, A. B., Joffe, A., Duggan, A. K., Casella, J. F. & Brandt, J. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet 348, 992–996 (1996). Visit our website www.ihpublishing.co.za GASTROENTEROLOGY South African Review