Sequential treatment of anemia in ulcerative colitis with intravenous ironand erythropoietin

Background: Intravenous iron and erythropoietin have been shown to be effec tive in Crohn's disease-associated anemia. The aim of this study was to tes t the sequential treatment of anemia in ulcerative colitis with intravenous iron in the fi rst phase and erythropoietin in the second. Patients and Me thods: Twenty patients with ulcerative colitis-associated anemia (hemoglobi n less than or equal to 10.5 g/dl) entered th is open-la bet trial. In the fi rst phase a ii patients received intravenous iron saccharate for 8 weeks . A response was defined as an increase in hemoglobin greater than or equal to 2.0 g/dl; a final hemoglobin >10.5 g/dl was regarded as fu II response, less than or equal to 10.5 g/dl as partial response, A hemoglobin increase <2.0 g/dl was regarded as nonresponse. in the second phase (n = 4) erythro poietin was initiated in patients without response, Patients with partial r esponse were continued on iron saccharate for another 8 weeks. Results: Dur ing the first phase the hemoglobin increased from 8.3 to 11.9 g/dl (mean he moglobin difference 3.6 +/- 2.3 g/dl, p < 0.001). Fifteen patients (75%) sh owed a full response (mean hemoglobin difference 4.5 +/- 1.5 g/dl), 1 (5%) a partial response (hemoglobin difference 2.1 g/dl) and 4 no response (mean hemoglobin difference 0.4 +/- 1.8 g/dl) with a need for blood transfusions in a single patient. In the second study phase erythropoietin was highly e ffective in previous nonresponders (mean hemoglobin difference 3.3 +/- 1.9 g/dl). The single patient with partial response had a minor hemoglobin incr ease (hemoglobin difference 1.0 g/dl), Conclusion: Most patients with ulcer ative colitis-associated anemia improve on intravenous iron alone. Erythrop oietin is effective in those who do not respond.