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Ongoing Blood Tests Not Needed for Children with Celiac Disease

Celiac.com 12/24/2015 - Laboratory tests for hemoglobin, ferritin, calcium, folate, vitamin B12, vitamin D, and thyroid function are regularly ordered in children with celiac disease, despite sufficient evidence for their necessity. To determine the frequency of nutritional deficiencies and levels of thyroid dysfunction in children with celiac disease, researches conducted a study that examined children before and after the initiation of a gluten-free diet.

Photo: CC--Randen PedersonThe research team included Margaretha Maria Susanna Wessels, MD, Iris I. van Veen, MD, Sabine Lisa Vriezinga, MD, Hein Putter, PhD, Edmond Henri Herman Maria Rings, MD, PhD, and Maria Luisa Mearin, MD, PhD. They are affiliated with the Department of Pediatrics, Department of Statistics, and the Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.

For their study, the team evaluated test results for hemoglobin, ferritin, folate, vitamin B12, calcium, vitamin D (25[OH]D), free thyroxin, and thyroid stimulating hormone of children with celiac disease regularly seen at the Leiden University Medical Center between 2009 and 2014. The team used laboratory reference ranges to define abnormal results. For statistical analysis, they used Pearson χ2 test for trend, unpaired t test, and 1-way ANOVA. 

Their results for 182 children evaluated, showed 119 were newly diagnosed. About 17% of results were missing for any given year, due to incomplete blood results.

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The most common deficiencies at the time of celiac diagnosis were iron deficiency, found in 28% of celiac patients, vitamin D deficiencies in 27%, and folate deficiency, in 14%. They also saw iron deficiency anemia in 9%, and vitamin B12 deficiency in 1% of celiac patients. They saw no hypocalcemia or thyroid dysfunction.

At follow-up, they observed iron deficiency, iron deficiency anemia, and folate and vitamin D deficiency 8%, 2%, 3%, and 25% of patients, respectively. They found no vitamin B12 deficiency, hypocalcemia, and thyroid disease.

From these results, the team concluded that complementary blood investigations are relevant at the time of celiac diagnosis, but have little follow-up use, once the patients adopt a gluten-free diet. They recommend that such tests be conducted only if there is a clear physical issue, such as fatigue or abnormal growth.

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2 Responses:

 
Nicole
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said this on
28 Dec 2015 5:10:28 PM PDT
Interesting... I think my family are oddballs as many of the research you have shared recently have been opposite for our personal experience. This is another one. Ongoing blood work has revealed new deficiencies in my kids despite adherence to GF diet and previous normal labs. Three of my four children (and myself) have celiac disease. My kids were diagnosed young (2, 4, 6 years of age). All were off the charts as far as growth. All were breastfed on demand for 20+ months. My first two (diagnosed at 2 and 4) were fed gluten at the normal time of 4-6 months. My third wasn't given any until a year old. My fourth (not celiac) didn't have any until she was regularly eating foods and could eat off my husband's plate so 1-2 years old.

My oldest, diagnosed at 4.5 and now almost 11, was the hardest hit and though symptoms wouldn't warrant testing now if we didn't routinely see a GI doc, we have been surprised with lab results at different times (anemia, low vit. d, low bone density, low calcium). I'm definitely sticking with the yearly labs.

It's interesting how we are all so individual.

 
Jefferson
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said this on
29 Dec 2015 11:57:05 AM PDT
Your personal experience my, in fact be valid. The study though, looks at the larger population of kids with celiac disease. It can still be true that some kids will benefit from such testing, AND that the population as a whole will not benefit from such testing.




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