The relationship between ulcerative colitis and anemia

People living with ulcerative colitis (UC) are at an increased risk of developing anemia. Anemia can be serious, but is treatable.
UC is a form of inflammatory bowel disease that causes inflammation in the large intestine.
People with UC are at risk of developing anemia, a condition in which there are lower levels of red blood cells and the protein hemoglobin in the blood. This can be due to problems caused by UC, including reduced iron absorption, reduced absorption of other vitamins and minerals, and blood loss.
Learn more about the link between UC and anemia, including symptoms, treatment options, and long-term outlook.
The link between UC and anemia
People with UC are at risk of developing anemia. Roughly 1 in 3 people who live with UC also have anemia.
1 in 3
In UC and Crohn’s disease, another form of inflammatory bowel disease, inflammation in the intestine can prevent the body from absorbing iron properly. This can cause low iron levels, leading to anemia.
can prevent
Intestinal bleeding may also result in blood loss, causing anemia. Anemia in people with UC could result from reduced absorption of vitamins and minerals, including vitamin B1 and folic acid. Some UC medications may also cause anemia.
may also
Signs and symptoms of anemia
Not everyone with anemia will experience symptoms, so it is important those with UC get a test for anemia.
If a person does experience symptoms of anemia, these may include:
headaches
lack of appetite
difficulty with concentration or cognitive function
irritability
fatigue
tingling in the hands or feet
numbness in the hands or feet
cold hands and feet
If anemia gets worse, more symptoms may develop. These include:
abnormal menstrual bleeding
ulcers in the mouth
blue-ish color in the whites of the eyes
brittle nails
lightheadedness
low libido in males
inflamed or sore tongue
shortness of breath
How doctors diagnose anemia
Doctors can diagnose anemia through a blood test to see if there are low levels of red blood cells and hemoglobin.
To diagnose anemia, a doctor may recommend tests for:
complete blood count
vitamin B12 levels
iron levels
folic acid levels
reticulocyte count, the amount of immature red blood cells in the blood
A doctor may also do a physical exam to check for:
rapid heart rate
pale skin
slight fever
heart murmur
low pressure, particularly upon standing
Treatment options for anemia
While anemia can be serious, it is also treatable.
Treatment options for anemia in people will UC will depend on the cause of the anemia and whether the UC is active.
A doctor will decide what treatment option is best, taking into account:
whether UC is active
whether other medical problems are present
whether other nutritional deficiencies are present
Iron supplements are one option for treating anemia in people with UC.
People who have UC in remission can take iron supplements orally. If someone with UC is in remission and can tolerate foods with iron, doctors recommend they begin to incorporate those foods into their diet.
If a person has UC that is not in remission, they may need to receive iron via an infusion with an IV line. This may also be the best option for those who cannot tolerate oral iron supplements.
A doctor may prescribe other supplements to counteract the reduced absorption of certain vitamins and minerals due to UC.
Supplements may include vitamin B12 and folic acid.
In some cases, doctors may use a blood transfusion to treat severe anemia.
Before a blood transfusion, a healthcare professional will test a person’s blood to identify their blood type.
They will then insert an IV line into a blood vessel to deliver healthy blood. Typically, a blood transfusion will take 1–4 hours to complete.
A blood transfusion helps increase the hemoglobin and oxygen levels in the blood.
Getting UC under control through appropriate treatment may help treat anemia. There is no cure for UC, but a multifaceted approach to treatment can help manage the disease.
may help
Treatment options for UC may include:
Medications: Possible medications include aminosalicylates, corticosteroids, immunomodulators, targeted synthetic small molecules, and biologics. Medication can help limit flare-ups and reduce inflammation.
Diet: Working with a doctor or dietitian to avoid foods that aggravate the digestive system may improve symptoms.
Surgery: Between 25–33% of people with UC do not benefit from medical therapy. For these people, doctors may recommend a surgery such as a colectomy.
25–33%
When to contact a doctor
If a person is experiencing symptoms of anemia or unusual blood loss, they should call a doctor.
It is important for those living with UC to be aware of symptoms that may indicate a flare-up or worsening of the condition.
Symptoms that may indicate a change in a person’s condition and require a call to the doctor may include:
weight loss
loss of appetite
frequent, watery diarrhea
diarrhea that contains blood, mucus, or pus
pain in the abdomen
a sense of urgency to have a bowel movement
fatigue
Any sudden or severe symptom requires attention from a doctor. In some cases, certain symptoms may warrant an emergency call to the doctor or a trip to the emergency room.
These symptoms include:
new rectal bleeding
significant amounts of rectal bleeding
a drastic change in bowel movements without passing gas
persistent vomiting and no bowel movements
severe abdominal pain that persists for more than an hour
a high temperature
Outlook
Those with ulcerative colitis (UC) are at risk of developing anemia due to reduced iron absorption and potential blood loss. Certain medications and reduced absorption of minerals may also play a role in those with UC developing anemia.
Not everyone with anemia will experience symptoms, and it is important those with UC get a blood test to check if they have anemia.
While anemia can be serious, it is treatable. Treating anemia may involve taking oral iron or intravenous supplements. Managing UC will also help in the treatment of anemia.