3. Prevalencia:
5% en pacientes
ambulatorios
9% en pacientes
con UC
35% en
pacientes
hospitalizados
50% en
pacientes con
EC
Epidemiología
Rejler M. Scand J Gastroenterol 2012; 47: 937-942
7. Anemia de enfermedad crónica
Guagnozzi D. World J Gastroenterol 2014; 20: 3542-3551
Disminución de
eritropoyesis por
IFN -γ, IFN-α,
TNF α, IL -1:
IL – 1 IL – 6, TNF
α: Disminución
Eritropoyetina
Bloqueo de los
receptores de
eritropoyetina
9. • Hemoglobina y conteo de reticulocitos
• Determinación de VCM
• Hemoglobina corpuscular media
• Proteínas C reactiva
• Estudios de Hierro
– Ferritina, Hierro total, saturación de transferrina
• Vitamina B12 y ácido fólico
Diagnóstico
Guagnozzi D. World J Gastroenterol 2014; 20: 3542-3551
Reinisch W. J Crohns Colitis 2013;7:429-40
14. Hierro oral vs IV
Avni T. PLoS One. 2013;8:75540
Reinisch W. J Crohns Colitis 2013;7:429-40
15. Valores de
Hemoglobina
g/dl
Peso menor 70 kg Peso mayor 70 kg
10 – 12 (Mujeres)
10 – 13
(Hombres)
1000 mg 1500 mg
7 - 10 1500 mg 2000 mg
Dignass AU J Crohns Colitis. 2014
Cálculo de la dosis de hierro
16. Manejo de anemia leve a moderada
Hb > 10 g/d – 12/13
Ferritina <100
ng/ml
Sat Transferrina <
20%
Hierro Oral (100
mg/dia)
4- 8 sem
Hb > 2g/dl
Hierro IV
completar dosis
Continuar terapia
Sucarato (7- 9 d)
100 – 200 mg
FCM (2 dosis ) 100
-1000 mg (15
mg/kg)
Isomaltósido 1000
mg LMWID (1
dosis) 100 – 2000
Dignass AU J Crohns Colitis. 2014
Reinisch W. J Crohns Colitis 2013;7:429-40
No
Si
17. Manejo de anemia severa
Hb < 10 g/d
Ferritina <100
ng/ml
Sat Transferrina <
20%
Sucarato (7- 9)
100 – 200 mg
FCM (2 dosis ) 100
-1000 mg (15
mg/kg)
Isomaltósido 1000
mg LMWID (1
dosis) 100 – 2000
Dignass AU J Crohns Colitis. 2014
Reinisch W. J Crohns Colitis 2013;7:429-40
4- 8 sem
Hb > 2g/dl
Monitoriza
ción
Agente
estimulant
e
Si
No
Notas del editor
Samuel Wilks, años 40 con el uso de la sulfasalazina, 5 Asa, y en los 60 con la mercaptopurina o azatioprina
Haptoglobina, LDH, BI, Coombs, creatinina
Patients are considered to suffer from IDA when they
present with low Hb (men < 13 g/dL, non-pregnant
women < 12 g/dL), TfS < 20%, and ferritin concentrations
< 30 ng/mL without any biochemical or clinical
signs of inflammation. A low MCH (< 27 pg) or even
better a low CHr (< 28 pg) rather than MCV (< 80 fL)
have became the most important red cell markers for detecting
iron deficiency in circulating red blood cells. Although
MCV is a reliable and widely available measurement,
it tends to be a relatively late indicator in patients
who are not actively bleeding[56]. A normal Hb level does
not rule out iron deficiency and with an MCH in the
lower limit of normal (normal range: 28-35 pg) or an increased
red cell distribution width (RDW, normal range:
11-15), one can suspect the presence of mild iron deficiency
without anemia[57]. Although the main laboratory
marker for iron deficiency with or without anemia is a
low ferritin level (< 30 ng/mL) in the absence of inflammation,
in the presence of inflammation a normal ferritin
level (as an acute phase reactant) does not rule out
iron deficiency; therefore, TfS should also be measured.
“Functional iron deficiency” in inflammatory conditions
should be defined by low TfS (< 20%) and normal ferritin
concentration (> 100 ng/mL), whereas low TfS (<
20%) and intermediate ferritin values (30-100 ng/mL)
suggest “absolute iron deficiency