S1840 Suboptimal Adherence to ECCO Guidelines for Screening of Iron Deficiency and Anemia in IBD: Findings From a Resident-Run Primary Care Clinic

Introduction: Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD), associated with fatigue, reduced quality of life, and worse clinical outcomes. Recognizing these impacts, the European Crohn’s and Colitis Organization (ECCO) published guidelines in 2015 recommending routine IDA screening in IBD patients every 6 to 12 months for those in remission and approximately every 3 months for those with active disease, using complete blood count (CBC), serum ferritin, and C-reactive protein (CRP). However, adherence in practice remains unclear. Methods: A resident-run primary care clinic at a Veterans Affairs medical center with 2,073 male patients was queried for those with inflammatory bowel disease, identifying 35. After excluding 8 patients due to misdiagnosis, transfer of care, death, or loss to follow-up, 27 remained for analysis. The electronic medical record (EMR) was reviewed in May 2025 to determine disease activity status (active or remission) and whether laboratory tests including CBC, ferritin, and CRP were obtained within the recommended intervals by ECCO. Results: The mean age was 73.9 ± 13.2 years. 10 patients (35.7%) had active disease, and 17 (64.3%) were in remission. A history of anemia (hemoglobin <13.5 g/dL) was documented in 20 patients (74.1%), and 6 (22.2%) had lab-confirmed anemia at chart review. Iron deficiency screening, defined as at least one ferritin level and transferrin saturation ever ordered during the patient’s care, was documented in 17 patients (63.0%). Only 1 patient (3.7%) had CRP measured in the past year. Overall, 17 of 27 patients (63.0%) had a CBC within the past year. Among those with active disease (n = 10), only 2 (20.0%) were up to date with ECCO-recommended screening (CBC and ferritin within 3 months). While 6 of 10 (60.0%) had a CBC in the past 3 months, only 2 had ferritin measured. In the past year, 8 (80.0%) had a CBC and 3 (30.0%) had ferritin checked. Among patients in remission (n = 17), 5 (29.4%) were up to date with screening. Ten (58.8%) had a CBC and 6 (35.3%) had ferritin measured in the past year. Conclusion: Although ECCO guidelines recommend routine iron deficiency screening in IBD, adherence in this primary care setting was suboptimal. Overall, patients were inadequately screened, and only a minority were current with the recommended testing intervals. These findings highlight missed opportunities for early identification and management of IDA and underscore the need for improved implementation in routine care.