Frequency of Anemia and Iron Deficiency in Ulcerative Colitis Patients in Clinical Remission as per the Patient-Reported Outcome (PRO-2) Score

Abstract

Background Iron deficiency anemia (IDA) is commonly present in patients with ulcerative colitis (UC) due to chronic blood loss, malabsorption, and chronic inflammation. Despite advances in the management of UC, the prevalence and clinical impact of IDA remain significant, potentially affecting disease progression, quality of life, and therapeutic response. Given the complex interplay between mucosal inflammation and systemic manifestations, early detection and optimal management of IDA in UC are crucial for improving patient outcomes. This study aimed to determine the prevalence, clinical characteristics, and treatment patterns of IDA in UC patients presenting to tertiary care centers in Karachi, Pakistan. Methodology This cross-sectional study was conducted in the Medical and Gastroenterology Department of Dr Ruth KM Pfau Civil Hospital Karachi and OMI Hospital from February 2024 and June 2025. Using non-parametric convenience sampling, adult patients (≥18 years) with a confirmed diagnosis of UC, based on clinical, endoscopic, and histopathological criteria, were enrolled consecutively. Data regarding demographics, duration and extent of disease, clinical activity (using the Patient-Reported Outcome (PRO-2) and Mayo scores), laboratory parameters (hemoglobin, serum ferritin, transferrin saturation, C-reactive protein), and treatment history were collected. IDA was defined as hemoglobin below the normal reference with evidence of depleted iron stores. Patients with other causes of anemia were excluded. Descriptive and inferential statistics were used to analyze the prevalence of IDA. Results In total, 216 patients met the inclusion criteria. The prevalence of IDA was found to be 76.9% among the study cohort. Of these, 27.8% were anemic with iron deficiency, 30.6% had anaemia of chronic inflammation with iron deficiency, and 18.5% had anemia of chronic inflammation without iron deficiency. Overall, 16.7% were non-anemic with iron deficiency, while 6.5% were non-anemic with adequate iron. Anemia was more prevalent in males compared to females. Conclusions IDA was a prevalent and under-recognized complication in patients with UC in the studied population. It was associated with greater disease activity and extent, yet remains inadequately managed in clinical practice. Proactive screening and timely initiation of appropriate iron replacement, particularly intravenous formulations, are recommended to optimize clinical outcomes, enhance quality of life, and support disease remission in UC. Future studies should explore barriers to optimal anemia management and evaluate the long-term benefits of integrated care approaches.