Jump to content
  • Sign Up
  • Join Our Community!

    Do you have questions about celiac disease or the gluten-free diet?

  • Jefferson Adams
    Jefferson Adams

    Celiac Disease Associated with Aplastic Anemia in a 6-Year-Old Girl

      The team managed the girl's condition with packed red cells, platelets, and diet restrictions, and the girl showed improving platelet counts over yearly follow up visits.

    Caption: Photo: CC--Steven Depolo

    Celiac.com 03/07/2018 - People with celiac disease can sometimes have hematological issues, including chronic anemia. It might be surprising to hear, but aplastic anemia and celiac disease share a similar underlying autoimmune process, but doctors haven't reported many cases that indicate that the two are connected. In fact, medical literature reveals only three pediatric cases indicating a connection. Recently, clinicians reported the first case in a female pediatric patient.

    The clinical team included Omar Irfan, Sana Mahmood, Heera Nand, and Gaffar Billoo, with the Medical College and the Department of Pediatrics at Aga Khan University Hospital in Karachi, Pakistan. Their team treated a 6-year-old South Asian girl who had bruises, petechiae, and recent history of loose stools. On evaluation, the team diagnosed the girl to have celiac disease and prescribed a gluten-free diet. Follow-up assessment including bone marrow biopsy showed the girl to have pancytopenia.

    The team managed the girl's condition with packed red cells, platelets, and diet restrictions, and the girl showed improving platelet counts over yearly follow up visits. Eventually, the girl will need a bone marrow transplant, and the team spoke about that to the girl's parents.

    This is now the fourth report indicating a connection between celiac disease and aplastic anemia in children, and the clinical team wonders if the connection might be more common than is currently understood.

    Timely treatment of celiac disease through strict gluten-free diet, or aplastic anemia through immunosuppressive therapy, could help reduce the development of other autoimmune conditions.

    Because all four pediatric cases reporting potential celiac disease/aplastic anemia association occurred in South East Asia, the authors suggest larger studies to explore this connection.

    Source:



    User Feedback

    Recommended Comments

    There are no comments to display.



    Join the conversation

    You can post now and register later. If you have an account, sign in now to post with your account.
    Note: Your post will require moderator approval before it will be visible.

    Guest
    Add a comment...

    ×   Pasted as rich text.   Paste as plain text instead

      Only 75 emoji are allowed.

    ×   Your link has been automatically embedded.   Display as a link instead

    ×   Your previous content has been restored.   Clear editor

    ×   You cannot paste images directly. Upload or insert images from URL.


  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Jefferson Adams
    07/29/2013 - Rates of celiac disease in Caucasian populations of European origin are pretty well documented, but little is known about its prevalence in non-Caucasians.
    Also, data shows that celiac disease is one likely cause of iron-deficiency anemia, but little is known about how celiac disease might contribute to iron deficiency in Caucasians, and especially non-Caucasians.
    A team of researchers recently looked at for links between celiac disease and iron deficiency in both caucasians and non-caucasians.
    The study team included Joseph A. Murray, Stela McLachlan, Paul C. Adams, John H. Eckfeldt, Chad P. Garner, Chris D. Vulpe, Victor R. Gordeuk, Tricia Brantner, Catherine Leiendecker–Foster, Anthony A. Killeen, Ronald T. Acton, Lisa F. Barcellos, Debbie A. Nickerson, Kenneth B. Beckman, Gordon D. McLaren, and Christine E. McLaren.
    To find individuals with iron deficiency and to determine celiac disease rates, the team assessed samples collected from participants in the Hemochromatosis and Iron Overload Screening study. They looked at blood samples from white men 25 years or older and women 50 years or older who participated in the Hemochromatosis and Iron Overload Screening study.
    Individuals with serum ferritin levels ≤12 μg/L were group as iron deficient, while those with serum ferritin levels >100 μg/L in men and >50 μg/L in women served as a control group.
    The team analyzed all samples for human recombinant tissue transglutaminase immunoglobulin A; positive results were confirmed by an assay for endomysial antibodies.
    The team assessed patients with positive results from both celiac disease tests as having untreated celiac disease. They excluded from analysis all subjects with a positive result from only one of the two tests.
    They analyzed HLA genotypes and frequencies of celiac disease between Caucasians and non-Caucasians with iron deficiency.
    In all, the team found 14 cases of celiac disease among the 567 study subjects (2.5%), and just 1 case of celiac disease among the 1136 control subjects (0.1%; Fisher exact test, P = 1.92 × 10−6). The case of celiac disease in the control group was in a Caucasian control subject. There were no cases of celiac disease found in non-Caucasian controls.
    All 14 of the cases of celiac disease found by the team were in the Caucasian group of 363 (4%). There were no cases of celiac disease in the non-Caucasian group of 204 cases (P = .003).
    Overall, individuals with iron deficiency were 28-times more likely to have celiac disease (95% confidence interval, 3.7–212.8) than were healthy control subjects. Also, and interestingly, 13 of 14 cases with celiac disease carried the DQ2.5 variant of the HLA genotype.
    This study shows that celiac disease is linked with iron deficiency in Caucasians. In fact, among Caucasians, celiac disease is rare among individuals without iron deficiency.
    It also shows that celiac disease is rare among non-Caucasians—even among individuals with common features of celiac disease, such as iron deficiency.
    The study team recommends that doctors conduct celiac screening on men and postmenopausal women with iron deficiency.
    Source:
    Clinical Gastroenterology and Hepatology. Volume 11, Issue 7 , Pages 808-814, July 2013

    Jefferson Adams
    Celiac.com 09/05/2013 - Current medical science describes diarrhea as a classical symptom of celiac disease, while anemia is described as an atypical or silent manifestation.
    However, there was actually very little information that accurately compares the severity of celiac disease between patients who present with anemia against those who present with diarrhea.
    A team of researchers recently set out to determine whether people with anemia have more severe celiac disease than people with diarrhea.
    The research team included H.A. Daya, B. Lebwohl, S.K. Lewis, and P.H. Green. They are affiliated with the Celiac Disease Center, Department of Internal Medicine at the Columbia University College of Physicians and Surgeons in New York.
    For their study, the researchers selected a study group of 727 patients from a database of celiac disease patients evaluated at a tertiary referral center between 1990 and 2011. They used the degree of villous atrophy and clinical and serologic parameters to determine the severity of the celiac disease for each patient.
    The team compared patients according to mode of presentation and sex. They also conducted age and sex-adjusted multivariable analyses to assess the association between the mode of celiac disease presentation and cholesterol level, bone density, severity of villous atrophy, erythrocyte sedimentation rate (ESR), and level of anti-tissue transglutaminase (anti-tTG).
    They found that just over three-quarters of the patients presented with diarrhea, while just under one-quarter presented with anemia; 92% of which was iron deficient anemia.
    Multiple regression analysis showed that celiac disease with anemia was associated with lower levels of total cholesterol (P=.02) and high-density lipoprotein (P=.002), and a higher ESR (P=.001) and level of anti-tTG (P=.01).
    In women only, celiac disease with anemia was associated with a lower level of cholesterol.
    Anemic patients were more than twice as likely to have severe villous atrophy and a low bone mass density at time they were diagnosed with celiac disease than were patients who presented with diarrhea.
    So, the results show that celiac disease patients who present with anemia have more severe disease than those who present with diarrhea. There also seem to be sex-specific differences with respect to the connection between anemia and the various features of celiac disease, such as cholesterol.
    Source:
    Clin Gastroenterol Hepatol. 2013 Jun 8. pii: S1542-3565(13)00775-1. doi: 10.1016/j.cgh.2013.05.030.

    Jefferson Adams
    Celiac.com 06/09/2014 - Anemia is extremely common in patients with celiac disease. In some cases, anemia may be the sole manifestation of celiac disease, but there is no good data on rates of celiac disease in Indian patients with nutritional anemia. A research team recently examined rates of celiac disease among nutritional anemia patients at a care center in India. The team included A. Kavimandan, M. Sharma, A.K. Verma, P. Das, P. Mishra, S. Sinha, A. Mohan, V. Sreenivas, S. Datta Gupta, and G.K. Makharia.
    For their study, the team conducted positive celiac disease screens on adolescent and adult patients presenting with nutritional anemia. They also prospectively screened for celiac disease using IgA anti-tissue transglutaminase antibody (anti-tTG Ab). Subjects with positive antibody screens received upper gastrointestinal endoscopy and duodenal biopsy.
    In all, the team screened ninety-six patients. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were receiving hematinics and 36.4 % had received blood transfusions. Nineteen patients had histories of chronic diarrhea persisting for an average of about ten years. Of those, the team found 13 patients with positive IgA anti-tTG Ab screens, 12 of whom agreed to duodenal biopsy.
    Ten patients showed villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six), while two patients showed no villous atrophy. In all, ten patients with nutritional anemia, defined as iron deficiency 9, vitamin B12 deficiency 1, were also diagnosed with celiac disease.
    Multivariate logistic regression showed age, duration of symptoms, and presence of diarrhea to be the main predictors of celiac disease. The team put all patients with celiac disease on gluten-free diet, supplemented with iron and vitamin B. All patients showed significant improvement in hemoglobin concentration.
    The team recommends celiac disease screening, and appropriate follow-up in all cases of unexplained nutritional anemia.
    Source:
    Indian J Gastroenterol. 2014 Mar;33(2):114-8. doi: 10.1007/s12664-013-0366-6. Epub 2013 Sep 1.

    Jefferson Adams
    Celiac.com 10/17/2017 - Are primary care physicians under-testing for celiac disease in patients with iron deficiency anemia? A new survey of primary care doctors indicates that they are.
    It's fairly common for people with celiac disease to develop iron deficiency anemia (IDA), but researchers don't know much about the frequency with which primary care physicians test for celiac disease in patients with IDA.
    A team of researchers recently set out to describe how primary care doctors approach testing for celiac disease in asymptomatic patients with IDA.
    The research team included Marisa Spencer, Adrienne Lenhart, Jason Baker, Joseph Dickens, Arlene Weissman, Andrew J. Read, Seema Saini, and Sameer D. Saini.
    They are variously affiliated with the Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America; the Department of Internal Medicine, Henry Ford Health System, in Detroit, Michigan, United States of America; the Department of Statistics, University of Michigan, Ann Arbor, Michigan, United States of America; the Research Center at the American College of Physicians, in Philadelphia, Pennsylvania, United States of America; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America, Ambulatory Care, Veterans Affairs Medical Center, Ann Arbor, Michigan, United States of America.
    For their study, the team began by electronically distributing a survey to primary care doctors who are members of the American College of Physicians. The survey asked whether doctors would test for celiac disease, either by serologic testing, referral for esophagogastroduodenoscopy [EGD], or referral to GI) in hypothetical patients with new IDA, including: (1) a young Caucasian man, (2) a premenopausal Caucasian woman, (3) an elderly Caucasian man, and (4) a young African American man.
    The team chose the scenarios to assess differences in testing for celiac disease based on age, gender, and race. They used multivariable logistic regression to identify independent predictors of testing.
    Testing for celiac disease varied significantly according to patient characteristics, with young Caucasian men being the most frequently tested (61% of respondents reporting they would perform serologic testing in this subgroup (p
    Interestingly 80% of doctors surveyed said they would definitely or probably start a patient with positive serologies for celiac disease on a gluten-free diet prior to confirmatory upper endoscopy, which is contrary to guideline recommendations.
    This survey indicates that primary care doctors are under-testing for celiac disease in patients with IDA, regardless of age, gender, race, or post-menopausal status. The majority of primary care doctors surveyed do not strictly adhere to established guidelines regarding a confirmatory duodenal biopsy in a patient with positive serology for celiac disease.
    Clearly, even with all of the advances in celiac disease awareness and with more refined protocols, primary care doctors have some work to do when it comes to testing IDA patients for celiac disease, and even more work to do in following proper referral guidelines before putting patients on a gluten-free diet.
    Source:
    PLOSONE

  • Popular Contributors

  • Forum Discussions

    Every celiac is different.  Reactions to gluten are different and so are healing times.  I am one of those who remains ill for months too.    Give it time.  I hope you feel better soon.  
    Sounds awful. My hit me a few days later this time. But I still feel the same three weeks later. Well, a little bit better as my headaches have worn off but I am still so dizzy and have numbness and tingling. It's so hard to concentrate. I feel horrendous but have been to the docs and hosp numerous times and they can't do anything.
    I sorta bump into walls a lot more, misjudge distances and hit my shoulder on door frames in a sort of totter fashion, catch myself almost falling sometimes on stairs, drop stuff, find I lose heat and cold sensitivity and often burn myself, or cut myself. These stick around for a while and slowly taper off. My ataxia normally hits hard the first day within hours of consuming the offending food I can lose full motor control and end up on the floor.
×
×
  • Create New...