P-217 Independent Diagnosis of Anemia in Pediatric Patients with Inflammatory Bowel Disease Results in Increased Initiation of Anemia Treatment. (February 2017)

• Record Type: Journal Article
• Authors: Martineau, Bernadette; Oloyede, Hannah; Reed-Knight, Bonney; Schoen, Bess
• Is Part Of: Inflammatory bowel diseases. Volume 23(2017)Supplement 1
• Publication Date: 2017-02
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000512733.90459.13
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Anemia is regarded as one of the most frequently occurring systemic problems in inflammatory bowel disease (IBD) known to have considerable impact on the quality of life of affected patients. Prevelance of anemia in IBD has been reported to range from 9% to 74%, though studies in children and adolescents have demonstrated this to be higher at 41%–74%. Although guidelines on the diagnosis and management of IBD-associated anemia have been established, it has been suggested that gastroenterologists tend to consider reduced hemoglobin levels as part of the expected clinical findings of IBD and thereby possibly neglect initiation of treatment. Our study aimed to look at the codiagnosis of anemia to determine if this has led to increased treatment by comparing the rates of therapy in patients codiagnosed with anemia versus those not codiagnosed. We hypothesized that patients who received the codiagnosis of anemia would have higher rates of therapy to correct the anemia. Methods: Using the WHO sex- and age-adjusted definitions of anemia we assessed the prevalence of anemia in patients attending the pediatric outpatient IBD clinic at our hospital where patients are seen until 21 years of age. In a retrospective chart review, we analyzed all patients with visits between January and August 2016. Of those, we reviewed all who had laboratory assessment which included hemoglobin and excluded those without labs. We determined which patients met the diagnostic criteria for anemia based on WHO definitions and further assessed: (1) whether the patient was diagnosed with ICD9 or ICD10 codes for anemia and/or noted by the gastroenterologist in the clinic visit dictation to have anemia and (2) intiation of therapy regardless of method (oral, intravenous or red blood cell transfusion). Results: Hemoglobin values of 251 pediatric patients with IBD were evaluated and the prevalence of anemia was 35% (88/251) in all patients. Therapy was initiated in 39% (34/88) of these patients. Thirty-seven (42%) patients with anemia received a separate diagnosis code for anemia or were noted to have anemia; of these patients, 22 (59%) received therapy. Fifty-one (58%) patients with anemia were not coded or noted to have anemia; of these patients 12 (24%) received therapy. Initiation of therapy in patients codiagnosed with anemia was significantly higher than in those patients not coded (59% versus 24%, P < 0.01). Conclusions: Despite the high prevalence of anemia in our patients with IBD, only 39% of patients with anemia received any type of anemia treatment. Therapy was more than twice as likely to be initiated for patients with the codiagnosis or notation of anemia as compared to those not independently diagnosed with anemia. Our study shows that the independent diagnosis of anemia results in increased initiation of treatment, demonstrating the need for more attention to this codiagnosis.