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How does anemia occur in crohn's disease?

How does anemia occur in crohn's disease?

How does anemia occur in crohn's disease?

What is crohn's disease and how can crohn's disease lead to anemia?
Crohn's disease is an inflammatory disease characterized by painful ulcers and inflammation of the lining of your digestive tract. The inflammation most often occurs in the lower part of the small intestine, but inflammation can occur simultaneously at several locations on the intestinal tract. If left untreated the inflammation can develop into deep ulcers causing severe abdominal pain diarrhea and bleeding. Food moving through your digestive tract can rub against the inflamed tissue causing them to bleed or your bowel may also bleed on its own. Usually the bleeding is noticed in your stool as bright red blood in the toilet bowl or darker blood mixed with your stool. Sometimes crohn's disease can be associated with occult bleeding (that is the bleeding is not noticed but happens internally). In severe disease, bleeding is often serious and ongoing. This bleeding leads to severe iron deficiency and reduced RBCs in you blood and is the cause of anemia in crohn's disease.
What are the causes of crohn's disease and who is at risk of developing crohn's disease?
Although the exact cause of crohn's disease has not been determined it is clear that heredity plays an important role in who gets the disease. It is believed that the inflammation may be due to a reaction of the immune system against bacterial or viral infection. About 20% of individuals with crohn's disease have a parent or sibling who also has the disease. The risk factors include age, with people in the age group of 20 to 30 years more likely to develop crohn's disease. Smoking, family history and a high fat diet also seem to increase the risk of developing crohn's disease. If you're Jewish and of European descent, you're four to five times as likely as other people are to have crohn's disease.
How is anemia in crohn's disease diagnosed?
In order to diagnose your anemia, your doctor may take your medical history, do a physical exam, and order diagnostic tests and procedures

Complete blood count (CBC)


This is one of the first tests your doctor will order. The CBC helps determine a number of things about your condition:


Hemoglobin level: The normal range of hemoglobin is 14-18 gm/dl for males and 12-16gm/dl for females. A low hemoglobin level may indicate Iron deficiency anemia (IDA) and is quite often seen in crohn's disease.

Hematocrit: The hematocrit level measures how much of your blood is made up of RBC. The normal range for hematocrit levels for the general population is 32-43 percent. A low hematocrit level is another sign of anemia.


The CBC also checks the number and size of your RBCs. In anemia due to iron deficiency the number of RBC is usually low and the RBCs are also smaller in size

If the CBC results confirm that you have anemia, your doctor may order additional tests to determine the cause, severity, and correct treatment for your condition. One such test your doctor might order is the reticulocyte count. Reticulocytes are young RBC. This test measures the number of new RBC in your blood. The reticulocyte test is used to determine whether your bone marrow is producing RBC at the proper rate.


In addition in diseases such as crohn's disease where internal bleeding is very common, your doctor may order tests to diagnose any internal bleeding.

Tests that diagnose internal bleeding

If your doctor suspects internal bleeding in your stomach or intestines, several tests may be ordered to determine the source of the bleeding:

Fecal occult blood test: This test checks your stool for signs of blood. If blood is found in the stool, further tests may be used to find the source of the bleeding:

Colonoscopy: In this test, a thin, flexible tube attached to a video camera is used to examine the rectum and colon to identify the source of bleeding.



Upper GI endoscopy: In this test, a thin, flexible tube attached to a video camera is used to examine the stomach and upper intestines for signs of bleeding.
How is anemia due to crohn's disease treated?
Treatment of anemia due to crohn's disease is focused on treating or managing the underlying cause of anemia and providing supplements to treat the anemia.

Severity and cause of your anemia determines the therapy that your doctor will advise. In most cases your doctor may prescribe iron supplements to treat your anemia. Your doctor may also prescribe vitamin C to help the body absorb iron from the food you eat. You doctor may also advice a diet rich in iron, folic acid and vitamin C. Vegetarians may be advised to include citrus fruits like oranges, grapes vegetables such as spinach and other dark green leafy vegetables. In severe and life threatening anemia, you may require hospitalization, blood transfusions, and iron injections.
References
    • Adamson JW. Iron deficiency and other hyperproliferative anemias. In: Kasper DL, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL, eds. Harrison's principles of Internal Medicine. 16th ed. Mcgraw-Hill Professional; 2005.