Differential diagnosis of anemia in ulcerative colitis: a clinical case

Anemia is the most common systemic complication of inflammatory bowel diseases (IBD), with a prevalence ranging from 6% to 74% in IBD patients. This article presents an analysis of a clinical case involving a patient with ulcerative colitis and mixed-genesis anemia and discusses the mechanisms underlying various types of anemia in IBD. Clinical case. Patient P., a 54-year-old woman with a history of ulcerative colitis, was hospitalized with complaints of weakness, reduced exercise tolerance, dry mouth, abdominal pain localized in the colon, increased bowel movements up to four times a day without blood, and a sensation of crawling ants on her skin. These symptoms developed after taking broad-spectrum antibiotics for one month. The patient independently increased the dosage of mesalazine to 2 g/day and started taking diosmectite and a Saccharomyces boulardii probiotic, which led to moderate improvement. Examination revealed hyperchromic macrocytic anemia of mixed origin (B12 and folate deficiency) of moderate severity. The condition was attributed to prolonged mesalazine use after ruling out other factors. Following a comprehensive treatment regimen, the patient was discharged in satisfactory condition. Conclusion. This clinical case highlights the importance of a differential diagnostic approach to identifying anemia in IBD patients. Diagnosis should consider both the pathogenic effects of the underlying disease and potential side effects of the therapy. Anemia, as one of the most common complications of IBD, significantly reduces patients’ quality of life and delays remission achievement.