Blood test help

[Youngmum85]

Please can someone explain how celiac disease might be picked up on a blood test. My daughter IgA is on the threshold of being low, 0.5 g/l. What does this mean? Is it high IgA that indicates celiac or low IgA? Other routine blood tests were normal apart from low eosinophil count and borderline low iron.

I’m so confused as to how to help my daughter, and doctors appointment to discuss results not for ages.

[Russ H]

1 hour ago, Youngmum85 said:

Please can someone explain how celiac disease might be picked up on a blood test. My daughter IgA is on the threshold of being low, 0.5 g/l. What does this mean? Is it high IgA that indicates celiac or low IgA? Other routine blood tests were normal apart from low eosinophil count and borderline low iron.

I’m so confused as to how to help my daughter, and doctors appointment to discuss results not for ages.

Hello

There are several types of antibodies (also called immunoglobulins) including IgA and IgG. About 1 in 100 people has low levels of the type IgA - this is often asymptomatic. It means that the standard coeliac disease test might not work, and instead an IgG test will be performed.

Low IgA of itself does not indicate coeliac disease.

Coeliac disease is a specific immune reaction to gluten protein found in wheat, barley and rye. As part of the immune response, people make antibodies to the gluten and also to an enzyme in the body which can be detected by a blood test. Commonly the test looks for anti-TG2 and anti-DGP antibodies.
 

[trents]

Welcome to the forum, Youngmum85!

Too which IGA test do you refer? There is not just one. For instance, there is total IGA and there is tTG-IGA. Can you be more specific? And how old is your daughter? Antibody testing for children is often unreliable, especially with regard to the tTG-IGA and so other antibody tests should be run, a "full celiac panel". Here is a primer: https://celiac.org/about-celiac-disease/screening-and-diagnosis/screening/

Since your handle is Youngmum85 instead of Youngmom85 I assume you are in the UK. Unfortunately, the NHS is quite strapped right now which leads to minimal testing protocols and long waits for follow-up appointments.

She may also have something called NCGS (Non Celiac Gluten Sensitivity) which shares many of the same symptoms as celiac disease but does not produce inflammation in the lining of the small bowel and hence, not antibodies are produced. There is no test available at this time for NCGS. Celiac disease must first be ruled out. But NCGS is 10x more common than celiac disease.

What are your daughter's symptoms?

 

[Youngmum85]

Thanks both for replying. All I have on the results is Immunoglobin A blood test and the normal ranges 0.5 g/l to 2.4 g/l, if that helps.

I’m wondering if they should have tested for other celiac related things at the same time. It is a bit of minefield to get help on the NHS for  vague symptoms like she has.

She is 8 and has had ongoing stomach pain that comes and goes for nearly year. It is not awful pain however enough that it makes her irritable and calpol helps.

She also has mucous in stool and enamel hypoplasia. And she has night sweats. Her weight is normal and Full Blood count normal so no one seems too concerned. Just not sure whether to push for more tests and what to ask for either.

[Scott Adams]

This article has some info on this as well, in her case a DGP-IgA and DGP-IgG tests should be done:

 

[trents]

Mucous in the stool, tooth enamel issues, and low iron are all classic symptoms of celiac disease. All of them suggest damage to the small bowel villous lining which, in turn, results in poor absorption of nutrients from the diet. And if I recall correctly, we have had forum participants list night sweats as one of their symptoms.

I would push for further testing that would include total IGA, Deamidated Gliadin IgA and IgG antibodies. There is also the option of paying out of pocket for third party home test kits from companies like Imaware. Be aware that she should not be reducing gluten consumption until all testing is complete. However, there is also the option of trialing a gluten free diet for several months to see if her symptoms improve. If you do that, however, your daughter would need to go back on regular gluten consumption for 6-8 weeks leading up to antibody testing.

[Youngmum85]

Thank you for the comprehensive information. I will ask for those tests/look into private blood testing if GP won’t do them!

[RMJ]

The test she had was total IgA (determined by the units and range). In addition to the deamidated gliadin antibody tests that Trents mentioned, she should have TTG (tissue transglutaminase) IgA and IgG tests.

[Russ H]

Your daughter seems to meets the criteria for being tested for coeliac disease. A link to the NICE guidelines is below. From your description, she has:

• enamel defects
• borderline anaemia
• persistent unexplained abdominal or gastrointestinal symptoms

Quote

1.2.3 When healthcare professionals request serological tests to investigate suspected coeliac disease in children, laboratories should:

test for total IgA and IgA tTG as the first choice

consider using IgG EMA, IgG DGP or IgG tTG if IgA is deficient.

https://www.nice.org.uk/guidance/ng20/chapter/Recommendations#recognition-of-coeliac-disease

Note that at 0.5 g/L, your daughter does not meet the criterion of being IgA deficient under NICE guidelines, which is < 0.07 g/L.