Anemia of Inflammation in Patients with Intestinal Failure on Home Parenteral Nutrition
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MEDICINE
Anemia of Inflammation in Patients with Intestinal Failure on Home Parenteral Nutrition Shweta S. Namjoshi 2 & Cristina Farkas 1,3 & Nicholas J. Jackson 4 & Laurie E. Reyen 5 & Pamela S. Baldivia 5 & Jorge H. Vargas 1 & Robert S. Venick 1 & Patricia L. Weng 1,3 & Mark R. Hanudel 1,3 & Tomas Ganz 1,6 & Laura J. Wozniak 1 Accepted: 10 July 2020 # Springer Nature Switzerland AG 2020
Abstract Anemia is common in intestinal failure (IF), but it is unknown if anemia in IF is due to iron deficiency or another etiology. Understanding iron status is important, as deficiency and overload are both associated with multisystem morbidity and mortality. The objective was to determine the etiology of anemia in a cohort of patients with IF and characterize iron status with respect to multisystem outcomes. This was a single center retrospective cohort analysis of iron parameters from August 1998 to March 2018 in 54 IF patients (355 person years). Thirty-eight percent of measurements showed iron deficiency, 36% anemia of inflammation, 21% indeterminate iron status, and 5% suggested iron overload. Mean direct and total bilirubin were elevated when ferritin was > 200 ng/mL and in inflamed and overloaded patients compared with iron-deficient patients. For every 10% increase in Tsat, bilirubin increased by 0.58 mg/dL from baseline (p = 0.003). Tsat > 50% had a mean positive culture probability of 60%. The probability of renal disease increased over time and average GFR decreased over time (−3.14 ± 1.37 mL/min per 1.73 m2), and nearly one in five patients in this study had chronic kidney disease (CKD). Patients with IF are at risk for both iron deficiency anemia as well as anemia of inflammation, with at a portion of patients with anemia of inflammation and overload having elevated risk of cholestasis, CKD, and infection compared to their peers. Careful assessment of inflammation, risk of infection, and renal function should be performed prior to dosing iron to ensure safe and effective delivery of this essential micronutrient. Future directions include determination of extra-renal sources of inflammation in IF. Keywords Anemia of inflammation . Iron deficiency anemia . Intestinal failure . Cholestasis . Iron . Hepcidin . Osteopenia . Infection . Intestinal failure-associated liver disease . Transferrin saturation . Ferritin . Nutritional immunity . Chronic kidney disease
Abbreviations IF Intestinal failure PN Parenteral nutrition IBD Inflammatory bowel disease
Tsat IFALD CKD IBC
Transferrin saturation Intestinal failure-associated liver disease Chronic kidney disease Iron-binding capacity
This article is part of the Topical Collection on Medicine Electronic supplementary material The online version of this article (https://doi.org/10.1007/s42399-020-00404-y) contains supplementary material, which is available to authorized users. * Shweta S. Namjoshi [email protected] 1
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
2
Division of Pediatric Gastroenterology, Hepatology, & Nutr
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