Anemia in Pediatric Intestinal Failure: Prevalence, Predictors and Etiologies

Strauss, Jaclyn Carla

Anemia in Pediatric Intestinal Failure: Prevalence, Predictors and Etiologies

dc.contributor.advisor	deBruyn, Jennifer
dc.contributor.advisor	Raman, Maitreyi
dc.contributor.author	Strauss, Jaclyn Carla
dc.contributor.committeemember	Fenton, Tanis
dc.contributor.committeemember	Galante, Gary
dc.contributor.committeemember	Samuel, Susan
dc.date	2025-02
dc.date.accessioned	2025-01-29T23:17:41Z
dc.date.available	2025-01-29T23:17:41Z
dc.date.issued	2025-01-22
dc.description.abstract	Children with intestinal failure (IF) are at high-risk for different types of anemia, including iron deficiency anemia (IDA), anemia of inflammation (AI) and mixed IDA/AI. Data on the prevalence and underlying contributors to the types of anemia in the pediatric IF population is limited. Therefore, the aim of this thesis was to examine the prevalence and contributions of the various types of anemia in children with IF and identify factors associated with these anemias. A 10-year retrospective, multicenter study of pediatric IF patients managed by three separate intestinal rehabilitation programs (IRPs) in Canada was conducted. Anemia was defined by age-specific hemoglobin values, and anemia types were classified using a combination of hematologic measures and iron indices. Univariable regression analysis was performed to evaluate for demographic and clinical factors associated with anemia and anemia types. Among ninety children with IF, the period prevalence of anemia was 83% [75/90], with 76% [55/72] of children experiencing chronic anemia, defined as anemia on ≥2 annual hemoglobin measurements. AI (44%) [40/90] and mixed IDA/AI (36%) [32/90] were more prevalent than IDA (17%) [15/90]; 26% [19/90] children developed >1 type of anemia over time, and 84% [191/227] of anemic hemoglobin measurements occurred while receiving iron supplementation, oral or in parenteral nutrition (PN). The prevalence of mixed IDA/AI was higher at 2 IRPs that did not have access to iron-supplemented PN (75% vs 9%; p<0.001), as was small intestine bacterial overgrowth (SIBO) (58% vs 28%; p=0.004) and gastrointestinal bleeding (39% vs 15%; p=0.001). Children receiving iron-supplemented PN had lower odds of mixed IDA/AI compared to no anemia (OR 0.06, p<0.001), while oral iron supplementation was associated with an increased odds of mixed IDA/AI compared to no anemia (OR 3.40, p=.01). This study demonstrated a high prevalence of anemia in children with IF, specifically mixed IDA/AI and AI. This anemia is often chronic and dynamic with evolving anemia types. Our results suggest that mode of iron supplementation may impact IF-associated complications and anemia types. Future studies exploring the complex interactions between the gut microbiome, mode of iron supplementation and inflammation on anemia in pediatric IF are needed.
dc.identifier.citation	Strauss, J. (2025). Anemia in pediatric intestinal failure: prevalence, predictors and etiologies (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.
dc.identifier.uri	https://hdl.handle.net/1880/120573
dc.language.iso	en
dc.publisher.faculty	Graduate Studies
dc.publisher.institution	University of Calgary
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	Anemia
dc.subject	Pediatric
dc.subject	Intestinal Failure
dc.subject	Prevalence
dc.subject.classification	Health Sciences
dc.subject.classification	Epidemiology
dc.subject.classification	Medicine and Surgery
dc.title	Anemia in Pediatric Intestinal Failure: Prevalence, Predictors and Etiologies
dc.type	master thesis
thesis.degree.discipline	Medicine – Community Health Sciences
thesis.degree.grantor	University of Calgary
thesis.degree.name	Master of Science (MSc)
ucalgary.thesis.accesssetbystudent	I do not require a thesis withhold – my thesis will have open access and can be viewed and downloaded publicly as soon as possible.