IBD And Anaemia: Symptoms, Tests and Treatment

• Home / Diseases & Ayurveda / Digestive Disorders / Ayurvedic Treatment For Inflammatory Bowel Disease (IBD) / IBD Complications, Related Conditions And Safety / IBD And Anaemia: Symptoms, Tests and Treatment

Anemia is the most serious and most common complication of Inflammatory bowel disease (IBD). Anemia is linked with chronic blood loss and iron deficiency. It happens due to gut inflammation, blood loss, and nutritional deficiencies. You may notice symptoms like fatigue, dizziness, rapid heartbeat, insomnia, and poor concentration during anaemia. Doctors may suggest some tests such as CBC, CRP, TSAT, and serum ferritin to study gut inflammation and severity of disease.

Why Anaemia Happens In IBD

Anemia in IBD usually has more than one cause. The main causes are:

• Blood Loss: Ulcers and intestinal inflammation can cause ongoing blood loss, especially during a flare. 
• Iron Deficiency: Blood loss can reduce the body's iron stores. 
• Chronic Inflammation: Ongoing inflammation affects how the body uses and stores iron, making it harder to produce enough hemoglobin. 
• Poor Nutrient Absorption: When the small intestine is affected during Crohn’s disease or has been removed surgically. Can reduce nutrient absorption such as iron and vitamin B12. 
• Low Food Intake: Abdominal pain, nausea, diarrhoea, or a reduced appetite during a flare may make it harder to get enough nutrients. 
• Medications or Other Conditions: Some medications or unrelated health problems can also contribute. 

Symptoms To Notice

Anemia in IBD can develop slowly, so the signs may be easy to overlook. You may notice:

• Fatigue or feeling weak more often 
• Getting breathless with normal activity
• Dizziness or light-headedness
• Headaches
• Pale skin
• Rapid or fast heartbeats
• Poor concentration or feeling mentally foggy
• Irritability and insomnia 
• Feeling less able to keep up with your usual activities

Blood Tests Used

Doctors may use a few blood tests to find out whether anemia is present and what is causing it. Doctors generally use these tests together rather than relying on one test: 

• CBC (Complete Blood Count): It checks hemoglobin, red blood cells, and their size. It is generally measured as Hb < 13 g/dL in males and <12 g/dL in females.
• Ferritin: It shows the body’s stored iron, but inflammation can reverse the result, so it cannot be tested alone.
• Serum Iron and Transferrin Saturation (TSAT): These tests measure how much iron is available for making red blood cells. 
• Vitamin B12 and Folate: These tests check for nutritional deficiencies that can cause anemia. 
• CRP and ESR: These tests measure inflammation and can help identify anemia related to active IBD.
• Reticulocyte Count: It shows whether the bone marrow is producing new red blood cells properly. 

Iron Deficiency Versus Inflammation

In IBD, anemia can be caused by iron deficiency, ongoing inflammation, or both at the same time. Iron deficiency often happens because of blood loss from the digestive tract or reduced iron intake and poor nutrient absorption. During IBD, the iron is already low, so ferritin and transferrin saturation (TSAT) may also be low. With inflammation-related anemia, the body may have enough stored iron, but inflammation makes it harder for the body to use that iron to make hemoglobin. Ferritin is often low with iron deficiency, while it may be normal or high during inflammation. This is why doctors usually look at TSAT, CBC, ferritin, and inflammation markers together before deciding treatment.  

Food Sources Of Iron

Eating iron-rich foods can help support healthy hemoglobin levels, although food alone may not be enough when deficiencies are significant. Plant-based sources are especially useful for a vegetarian diet. During an active flare, choose options that you tolerate well.

Good Food Sources Include:

• Lentils and dal
• Chickpeas and beans
• Soybean and tofu 
• Spinach and other leafy greens
• Sesame and pumpkin seeds
• Nuts
• Iron-fortified cereals
• Dry fruits such as raisins and apricots
• Fermented foods such as kimchi and yogurt
• Vitamin-rich foods such as kiwi, lemon, guava, oranges, strawberries, amla, and bell peppers.

Oral Versus Intravenous Iron Overview

Both oral and intravenous (IV) iron can be used to treat iron deficiency in IBD. The choice depends on the severity of the anemia, disease activity, how well the person tolerates oral iron, and whether the body is likely to absorb it properly. 

Oral Iron is taken as a tablet, capsule, or liquid form, and it is convenient and inexpensive for many people. However, it can sometimes cause nausea, stomach discomfort, constipation, or diarrhoea, which may be difficult to manage during an IBD flare. Oral iron requires 3-4 months of consistency.

IV Iron is given directly into the veins or bloodstream. It does not depend on intestinal absorption. It may be considered when oral iron is not tolerated, cannot be absorbed properly, is not working well, or iron needs to be replaced more quickly. Intravenous iron delivers a large amount of iron in a single short series, but the limitation is that it is expensive and carries a high risk of hypersensitivity reactions or allergies.

The right option varies from person to person and depends on the person’s blood results, IBD activity, and medical history. Iron treatment should be guided by a professional.

Treating Active IBD

When anemia is confirmed with IBD, treatment focuses on replacing the lost iron and managing the reason it was lost. If active intestinal inflammation or ongoing bleeding is present, treating the IBD is also important so the anemia does not keep coming back.

• Oral Iron may be used when anemia is mild, and the person can tolerate it.
• IV Iron may be considered when oral iron  causes troublesome side effects, is not absorbed well, or when quicker replacement is needed.
• Active inflammation and bleeding should be assessed and treated as appropriate.
• Blood tests and repeated tests may be needed to check whether haemoglobin and iron levels are improving.

Ayurvedic Approach 

Ayurveda sees anemia with IBD as Grahani Roga or Raktatisaar and focuses on healing the gut lining over aggressive supplementation. Oral supplements are generally highly astringent in nature; taking them during an active flare can trigger severe cramping, inflammation, and worsen diarrhoea; that’s why Ayurvedic treatment focuses on stopping blood loss, calming Pitta dosha, and restoring the gut’s absorbing power with different Ayurvedic therapies. The core Ayurvedic treatment includes:

• Rakta Stambana to stop bleeding and heal ulcers
• Agni Deepana & Ama Pachana to kindle digestive fire and clear toxins
• Grahi to improve intestinal absorption
• Rakta Vardhana to build blood.

During a flare, an Ayurvedic expert may suggest Takra kalpana, Picha basti, soothing herbs like Kutuja, Bilva, Dadima, and Licorice to stop diarrhoea, reduce inflammation, and cool the GI tract. Dietary measures are also introduced to maintain remission and cool the gut.

When Symptoms Need Prompt Care

Most anemia symptoms can develop slowly, but some signs need medical attention early. Contact your doctor if tiredness, dizziness, breathlessness, or weakness is getting worse, especially if you have known IBD and your symptoms are affecting daily activities. Seek urgent medical care if you have heavy or ongoing rectal bleeding, black or bloody stools, fainting, chest pain, irregular heartbeat, or extreme weakness. These symptoms may include significant blood loss or severe anemia and should not be ignored.

B12 And Folate

B12 and folate help the body make healthy red blood cells. In IBD, low levels can occur due to poor intake, reduced absorption, or bowel surgery. Dairy products, fortified foods, leafy greens, beans, lentils, and citrus fruits can help. Tests can identify the deficiencies. The doctor may recommend some supplements if levels are low.

Blood Loss

Inflammation and ulcers in the digestive tract can cause ongoing blood loss in IBD. Even small amounts of hidden bleeding over time can reduce iron stores and lead to anaemia. It includes rectal bleeding, blood in stools, hidden blood loss, low iron, and low hemoglobin.

Do Not Start Supplements Without Checking The Cause

Do not start iron, B12, or other supplements without first checking the cause of anaemia. Different types of anaemia need different treatment, and unnecessary supplements may not address the actual problem blood test can help identify whether the issue is iron deficiency, inflammation, vitamin deficiency, or blood loss.

Reference 

Diagnosis and treatment of anemia in patients with inflammatory bowel disease - PMC

Iron deficiency anemia in inflammatory bowel disease - PMC

Iron deficiency or anemia of inflammation?

Efficacy of oral vs. intravenous iron for the treatment of iron deficiency anemia in different conditions: A systematic review and meta-analysis - PMC

Pathogenesis and treatment of anemia in inflammatory bowel disease - PMC