Anemia and Crohn’s Disease

Anemia and Crohn’s Disease: A Case of Successful Diagnosis of Prolonged Hidden Bleeding


A 33-year-old woman presented to the endoscopy department.
The patient complained of general weakness, fatigue, and decreased productivity.

She also noted that she appeared very pale.


The woman came with the results of a complete blood count. Attention was drawn to the low level of hemoglobin – 67 g/l, ferritin – 1.5 g, and serum iron – 2.4 µmol/l. It was found that her hemoglobin had been low for 7 years.

When the patient first learned about this, she consulted a therapist who prescribed her a 3-month course of iron. She felt better, but as soon as she stopped taking the medication, her hemoglobin level dropped again. The patient also consulted with other specialists and underwent several courses of medication, but it did not yield results.

The woman has a balanced diet, including protein.

No one in her family had Crohn’s disease, non-specific ulcerative colitis, or other inflammatory bowel diseases.


Visually, the patient appeared normal but was very pale. Blood pressure – 120/80 mmHg, pulse – 72 beats per minute. The abdomen was soft and painless, the liver and spleen were not palpable. Urination and stool were normal.

Instrumental diagnostics revealed:

  • Esophagogastroduodenoscopy found signs of superficial gastritis;
  • Videocolonoscopy showed an ulcer in the ileum and Crohn’s disease;
  • Ultrasound of the abdominal and pelvic organs, as well as chest X-ray, did not reveal any pathology.


  • The woman was referred to a gastroenterologist, who prescribed a long course of drugs from the sulfasalazine group and iron supplements.

After 2 weeks, and then a month, she was supposed to undergo a blood test to check hemoglobin, ferritin, and serum iron levels. Also, after 3 months, the patient was scheduled for colonoscopy.

After 2 weeks, the hemoglobin level increased to 98 g/l, and ferritin – to 5 g. The woman felt better and gained strength.

Based on the achieved result, she was prescribed continued intake of iron and sulfasalazine drugs.


This clinical case demonstrates the need for thorough and comprehensive diagnostics. For a long time, the woman had bleeding, which weakened her body, while therapy provided a quick and good result.

Only determining the exact cause allows choosing a treatment strategy that will provide a long-term effect and avoid serious complications, such as intestinal perforation, bowel obstruction, and even ulcer malignancy.