Paediatric onset IBD often present with anaemia. The cause of anaemia is multifactorial and include blood loss, iron deficiency, chronic inflammation, malabsorption and vitamin deficiencies. Occasionally blood transfusion is required to ensure a patient is stable for any diagnostic endoscopic procedure under a general anaesthetic. The COVID-19 pandemic disrupted access for children requiring diagnostic endoscopy and has contributed to children presenting with increased levels of morbidity. There is paucity of data on the impact of the pandemic on paediatric IBD services.

To assess whether there has been a difference in the requirement of blood transfusions for children accessing diagnostic endoscopy services post-pandemic, compared with children accessing the service pre-pandemic.

This was a retrospective study looking at the records of new onset PIBD in two distinct 12-month periods; pre-pandemic (01/01/2019- 31/12/2019) and post-pandemic (01/09/2021–31/08/2022). Data collected included type of disease, age at diagnosis, pre-endoscopy haemoglobin, requirement of blood transfusions peri-endoscopy (defined as a week prior to up to 4 weeks following an endoscopy). Decision for transfusion was decided based on haemoglobin level and clinical stability. Results were analysed using an excel spreadsheet.

In the pre-pandemic period 44 children were diagnosed with new onset IBD. The mean age of diagnosis was 12y 4 months (range 3 years 5 months to 17 year 11 months. A total of 4 patients required a transfusion pre-endoscopy. Each patient received 1 unit (mean units received 1.0; 3 UC, 1 CD, 0 IBDU). No patients required a blood transfusion within a month post endoscopy.

In the post-pandemic period 58 children were diagnosed with new onset IBD. The mean age at presentation was 12y 6 months (range from 3 years 10 months to 17 years 4 months). A total of 11 patients required transfusion peri-endoscopy, requiring 17 units in total between them (mean units received 1.54; 7 UC, 2 CD, 2 IBDU). 9% of children required a transfusion in the pre-pandemic period vs 18.9% of children in the post pandemic period. Compared to the pre-pandemic period, there has been a threefold increase in the use of red cell products for children with new onset IBD undergoing endoscopy.

There appears to be a greater need for red cell transfusion in children undergoing endoscopy than was the case pre-pandemic. This may be the result of children waiting longer for diagnostic procedures and delayed presentations through usual pathways. Ongoing disruption in access to diagnostic endoscopy in children may also impact blood transfusion services and needs to be planned for in the recovery of paediatric endoscopy services.