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Thrombocytopenic Purpura and Celiac Disease

The following was prepared by Ron Hoggan:

I have only found three reports in the literature suggesting a coincidence of the two above-mentioned conditions (1, 2, 3). And yet, I was recently contacted by Karen Brinser, whose mother had been diagnosed with celiac disease and had a section of her bowel was surgically removed due to a small bowel adenocarcinoma. Karen indicated she had ITP, and asked if there could be any connection with celiac disease.

I responded with the three citations to journal articles, along with some comments from Cooke & Holmes indicating that the platelet count could rise in celiac disease (4) (page 122). I seem to have missed the comment, later on the same page, that the platelet count can also be considerably diminished in the presence of granulopenia. They go on to say that granulopenia is not uncommon in celiac disease, and approximately 10% of celiac patients have total white cell counts less than 3500 per cmm and approximately the same percentage have either a neutropenia of less than 3000 or a lymphopenia of less than 1500 per cmm.

Karen took the initiative and posted to the celiac listserv asking for responses from those who have experience with both celiac disease and ITP. One parent wrote about a daughter who had previously experienced ITP, but had regained her health since the diagnosis and treatment of her celiac disease.

A middle-aged man who had suffered from ITP during the 1960s and 1970s and was treated with corticosteroids, was diagnosed with celiac disease in 1980. His ITP also seems to have resolved.

A woman was diagnosed with both celiac disease and ITP at the same time, three years ago. Her gastroenterologist thought the two were related as both are auto immune diseases.

Another woman had two severe bouts with reduced platelet levels occurring at ages 38 and again at age 45. At age 59 she was diagnosed with celiac disease and now blames the celiac disease for a variety of health problems, including her bouts with abnormal platelet levels.

Another womans ITP eventually led her astute (my opinion) doctor, after excluding leukemia, in the direction that led to the diagnosis of her celiac disease.

A father discussed his own and his daughters symptoms of purpura, as well as some associations between celiac disease and damage to capillaries. He structured some very thoughtful, compelling arguments suggesting that abnormal WBCs and platelet counts may well be associated with celiac disease. He also indicated that his symptoms had abated on the gluten-free diet.

Another parent had one daughter diagnosed with celiac disease. When their other daughter started to develop symptoms of celiac disease they put her on a gluten-free diet. At age five, they re-introduced wheat to her diet to see if she could tolerate it. She was subsequently hospitalized due to ITP. At the time, the parents thought the ITP might have been due to a drug reaction. The daughter was returned to the gluten-free diet due to other celiac-like symptoms, and has not had any significant health problems since. All these anecdotal reports, but in combination with Cook & Holmes comments, and the three journal articles, the possibility of a connection seems reasonable. It is at least a connection worthy of investigation, as ITP can be deadly, as can some of the other sequelae of celiac disease. Given the delays between presentation of ITP, and diagnosis of celiac disease, the former could prove to be a valuable indicator of the possibility of the latter.

If you have questions for Karen Brinser, she can be reached at: brinser@lancnews.infi.net

Sources:

  • Kahn O, Fiel MI, Janowitz HD Celiac Sprue, Idiopathic Thrombocytopenic Purpura, and Hepatic Granulomatous Disease. An Autoimmune Linkage? Clin. Gastroenterol. 1996 Oct;23(3):214-216.
  • Sheehan NJ, Stanton-King K Polyautoimmunity in a Young Woman. Br. J. Rheumatol 1993 Mar;32(3):254-256.
  • Stenhammar L, Ljunggren CG, Thrombocytopenic Purpura and Celiac Disease, Acta Paediatr Scand, 1988 Sep; 77(5):764-766.
  • Cooke W & Holmes G (1984) Celiac Disease Churchill Livingstone, NY.
  • Nelson E, Ertan A, Brooks F, Cerda J, (1976). Thrombocytosis in Patients with Celiac Sprue. Gastroenterology 70, 1042-1044.
  • Croese J, Harris O, Bain B,(1976). Celiac Disease. Haematological Features and Delay in Diagnosis. Medical Journal of Australia 6, 335-338.
  • Bullen A, Hall R, Brown R, Losowsky M, (1977). Mechanisms of Thrombocytosis in Celiac Disease. Gut. 18, 962.

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10 Responses:

 
Catherine
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
said this on
03 Dec 2007 12:59:08 PM PST
Hi there. I need help. My daughter and I both have celiac disease, biopsy proven and we're still have many problems. I'm more concerned about her right now. She is getting what seem to be blood blisters in her mouth, during or after exercise or a stressor of some kind. She has severe chronic fatigue and nauseousness. When bruised or cut, it takes months sometimes to clear the injuries up.

Apparently all the blood screens have been done and the doc won't discuss anything further with us. There are no thyroid or autoimmune indicators either.

I need some help.

Thanks so much just for thinking about us.

God Bless,

Catherine

 
doctorx

said this on
09 Oct 2014 11:04:37 AM PST
Change to another doctor.

 
Jennifer
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
said this on
22 Jan 2009 12:06:30 AM PST
Catherine-
I was reading your comment about your daughter. I was diagnosed with celiac disease about 2 years ago. I was still getting very sick and still had skin issues even while on my gluten free diet. I went through EVERYTHING i used and found out that over half of my shampoos, lipsticks and makeup had gluten in them. I don't know if this information will help you or your daughter any, but I never thought to look at any of those things when I was first diagnosed. Another thing I wasn't told was to avoid foods that were high in fat, such as peanuts. The doctor told me that due to my intestines being damaged that I couldn't digest high fat foods. I was eating a lot of peanuts and within a day or so of eating them I would be incredibly sick to my stomach. I still eat them, but since I have cut down on them I no longer have a problem. Also, I had ITP when I was a toddler. I don't remember much other than being hospitalized, but I was told I had bruises everywhere that wouldn't heal and it had to do with my decreased platelet count. I hope this information can help you out. Good luck to you and your daughter.
Jennifer

 
Catherine T.

said this on
10 Oct 2013 7:19:38 AM PST
I too, had ITP for years, then the doctors said I had Lupus SLE...sick in bed for years while my kids were toddlers... this went on for 1/3 of my life! One day I had a peanut butter cup and I went into anaphlaxic shock. I was referred to an allergist and found out I was celiac and allergic to most grains and any food that grew in the ground like peanuts, potatoes, carrots...etc...I quit eating all the food I was allergic to and I have my life back. I almost had a nervous breakdown realizing that it was the food all along....I am so healthy ...I work full time, exercise, eat only organic (no chemicals)...but I had a set back about 5 years ago and my hair was falling out and I was bruising again and I asked God to please show me what I was doing that was causing this.....I looked at my shampoo and conditioner and it had WHEAT GERM in it.....I started to cry when I realized that all the stuff I was putting on my body was full of gluten and wheat....carrot juice...soy.....jezzzz....Once I got the outside and my inside free of gluten I was on the road to a new life!!! I am almost 60 years old and I have never felt better in my entire life!

 
Jane
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said this on
10 Apr 2010 6:25:49 PM PST
I was diagnosed with Celiac Disease when I was 47 years old. Now, eight years later, I look and feel like a new person. Yesterday I accidentally ran across a picture of me with purpura my daughter and I pointed to it at the same time, recognizing it as the horrible rash I used to get on most vacations that covered my legs. Until now, I didn't know what it was called or what caused it, and tried to rationalize it by saying that I took more aspirin on vacations. Your article helped me to realize that this was just another symptom of celiac disease. Those symptoms were made worse during vacations because we often ate quick and inexpensive foods like sandwiches, pizza, crackers and cookies. Now I'm wondering if the increase in pain during those vacations wasn't due to internal bleeding caused by ITP. The good news is that I haven't had any of those disfiguring rashes since I've been gluten free.

 
Catherine A. Becker
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said this on
30 Dec 2011 1:05:51 PM PST
Thank you, My oldest daughter had ITP when she was 6-8 years old. Since then a Granddaughter, and three of my 4 children as well as myself have been diagnosed with celiac disease when I was 63. The oldest daughter will not have the testing for celiac disease, she is now 50 years old. Thank you for your information.

 
Pamela Miller
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said this on
08 May 2012 9:20:37 PM PST
My daughter has celiac disease last year she got off her diet in October of 2011 she got ITP the doctors kept saying there is no such thing...I think otherwise.

 
jennifer
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said this on
12 Jul 2012 9:55:34 AM PST
Two years ago, my 10 year old presented with bloody noses and bruises all over her body. She began vomitting and had diarrhea almost every day. She had many tests done. They discovered Idiopathic thrombocytopenic purpura. One week prior to this, she was mildly ill. It was August, she had a very low grade fever--around 100. She did not feel like herself for the day and then one week later, she had all of these symptoms. I took her to the doctor for a stomach ache who noticed her bruises and was concerned about the bloody nose. Tests showed platelets at 10,000. Then 2 days later the vomiting and diarrhea began. All testing showed no allergies or celiac disease. I kept a food diary and determined it was gluten. Her Idiopathic thrombocytopenic purpura went away but every once in awhile, if she is exposed to a bit of gluten, she begins with a bloody nose and if there is more exposure--the stomach issues begin--aches, then diarrhea and vomiting. I firmly believe Idiopathic thrombocytopenic purpura and gluten intolerance are linked--it is the case in my daughter though the doctors said then that they were not linked. I knew they were and am glad to see research coming out proving I am not nuts. Hope this helps someone else.

 
Lisarose
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said this on
26 Jul 2012 1:22:05 PM PST
Hello All!!
At 17 years of age I developed idiopathic thrombocytopenic purpura. I am 47 years old now, and back then the treatment for ITP was prednisone and eventually a splenectomy. I was diagnosed about 20 months ago with celiac disease. I never had the classic bloating, diarrhea, gastrointestinal upset symptoms, I was just very anemic. I did however suffer from chronic ideopathic pancreatitis and frequent bouts of syncope. I eventually had a cardiac arrest and was fitted with a pacemaker. Since going completely gluten-free, my pancreas has settled quite a bit, but I continue to have chronic fatigue and skin rash. Thank you so much to the previous comments because I am going to look into the shampoo soap connection with gluten. At the end of the day, all is well. We are survivors!

 
Kristi Tidwell
Rating: ratingfullratingfullratingfullratingemptyratingempty Unrated
said this on
08 Jan 2015 5:53:52 PM PST
My son who is 13 was just diagnosed with both ITP and celiac disease. I anxious to see once we start treating the celiac if his platelet level will start to improve. Last time he was checked it was only 42,000. I truly believe there is a connection.




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