Questions after blood test results

[Rachy265]

Hi. My 16 year old daughter has been suffering with stomach pains, bloating, gas, occasional vomiting, tiredness and loose stools for a number of months. We thought it was a symptom of anxiety as this has also flared up. Her doctor has run some blood tests and found the following abnormalities:

- Iron-deficient anaemia (serum ferritin 5ug/L) and slight folate deficiency

- anti-tissue transglutaminase level of 31.4 U/ml (with a note from the lab to say IgA TTg results to follow)

We are awaiting an appointment to speak to the doctor again but she has been prescribed iron tablets in the meantime. There are no obvious explanations for the anaemia as she's on medication to stop her periods and she eats a good diet, including meat and green leafy veg etc.

She is taking the iron tablets with food but is getting even worse stomach pain than before.

Could anybody please help me to understand the following:

1. Are her anti-tissue transglutaminase levels indicative of Celiac Disease?

2. What is the IgA TTg test that they talk about, and how is it different from the anti-tissue transglutaminase test?

3. Are there any other more stomach-friendly iron supplements we could ask her doctor to prescribe? (We are in the UK so we don't pay for her prescriptions)

Thank you in advance for your help

[trents]

Welcome to the forum, Rachy265!

Not sure how the anti-transglutiminase differs from the tTG-IGA. I have run across the anti-transglutenminase lab recently on this forum and I assumed it to be an alternate way of expressing tTG-IGA. Now I'm not sure. By the way, when you post test numbers make sure you post the reference ranges for negative vs. positive since there are no industry standard ranges for these tests. Each lab uses their own.

Since you didn't specify what kind of iron tablet your daughter is taking now, we cannot off an alternative suggestion except to say that if she is on a non-buffered iron tablet you need to look at a buffered iron product.

[Rachy265]

8 minutes ago, trents said:

Welcome to the forum, Rachy265!

Not sure how the anti-transglutiminase differs from the tTG-IGA. I have run across the anti-transglutenminase lab recently on this forum and I assumed it to be an alternate way of expressing tTG-IGA. Now I'm not sure. By the way, when you post test numbers make sure you post the reference ranges for negative vs. positive since there are no industry standard ranges for these tests. Each lab uses their own.

Since you didn't specify what kind of iron tablet your daughter is taking now, we cannot off an alternative suggestion except to say that if she is on a non-buffered iron tablet you need to look at a buffered iron product.

Thanks for the reply trents. The blood test negative ranges were given as follows:

Anti-tissue transglutaminase levels: <15 U/ml (Result 31.4 U/ml - Abnormal)

Serum ferritin: 30-150 ug/L (Result 5ug/L - Abnormal)

Her iron tablets are Ferrous Fumarate (322mg)

[trents]

It doesn't sound like the iron product she is on is buffered (also known as "slow iron") but you might aske the physician about this. I'll try and get back to you about the anti-transglutiminase vs. tTG-IGA. We have some moderators on this forum that work in medical science fields who would probably know the answer.

Edited September 22, 2023 by trents

[Rachy265]

6 minutes ago, trents said:

It doesn't sound like the iron product she is on is buffered (also known as "slow iron") but you might aske the physician about this. I'll try and get back to you about the anti-transglutiminase vs. tTG-IGA. We have some moderators on this forum that are work in medical science fields who would probably know the answer.

Thank you!

[trents]

One thing I will add and that is iron supplements are better assimilated when you take them with acidic food like orange juice or tomato juice. Taking a vitamin C tablet along with the iron supplement would accomplish the same thing. Some commercial forms of iron supplements are actually combined with vitamin C in the tablet.

[knitty kitty]

If Total serum IgA is deficient (as sometimes is with anemia), the tTg IgA test may register a false negative.  

However, there is another test, the tTg IgG that is used.  

IgG and IgA are different types of Immunoglobulins.  Both types are present in Celiac Disease.  

Perhaps you have the results of the tTg IgG test, with the tTg IgA test to follow.

Did they do a genetic test?  

Related reading....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816937/

And...

https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/digestive-diseases/celiac-disease-health-care-professionals

Edited September 22, 2023 by knitty kitty
Add links

[Rachy265]

6 minutes ago, knitty kitty said:

If Total serum IgA is deficient (as sometimes is with anemia), the tTg IgA test may register a false negative.  

However, there is another test, the tTg IgG that is used.  

IgG and IgA are different types of Immunoglobulins.  Both types are present in Celiac Disease.  

Perhaps you have the results of the tTg IgG test, with the tTg IgA test to follow.

Did they do a genetic test?  

OK, that makes sense, thank you. She hasn't had any genetic testing done.

[trents]

But kk, what is the "anti-tissue transglutaminaise" test? The "anti" part is what's confusing me.

[knitty kitty]

Tissue transglutaminase is an enzyme used in the body by cells for growth and repair and is found on cell surfaces as well as inside cells.

Anti-tissue transglutaminase antibodies (immunoglobulins like IgA and IgG) attack the tissue transglutaminase enzymes on cell surfaces.  

Segments of gluten and casein can resemble segments of tissue transglutaminase.  The antibodies cannot distinguish between gluten and tissue transglutaminase, so both get attacked, which means our body cells get attacked.  

So, the test would properly be called anti-tissue transglutaminase immunoglobulin tests or anti-tTg antibody tests.  But things get shortened.  

 

[trents]

So

29 minutes ago, knitty kitty said:

Tissue transglutaminase is an enzyme used in the body by cells for growth and repair and is found on cell surfaces as well as inside cells.

Anti-tissue transglutaminase antibodies (immunoglobulins like IgA and IgG) attack the tissue transglutaminase enzymes on cell surfaces.  

Segments of gluten and casein can resemble segments of tissue transglutaminase.  The antibodies cannot distinguish between gluten and tissue transglutaminase, so both get attacked, which means our body cells get attacked.  

So, the test would properly be called anti-tissue transglutaminase immunoglobulin tests or anti-tTg antibody tests.  But things get shortened.  

 

So, Rachy265's doctor was using "anti-tissue transglutaminase" as the unabbreviated form of tTG-IGA. Correct?

Edited September 22, 2023 by trents

[knitty kitty]

"anti-tissue transglutaminase  antibody test" can be tTg IgA or tTg IgG.

@Rachy265 said... "a note from the lab to say IgA TTg results to follow".

So the results she did receive must be the tTg IgG.   

 

[trents]

What was confusing, however, was that "a note from the lab to say IgA TTg results to follow came after the result for the anti-tissue transglutaminase had already been given.

 

Rachy265, I expect the physician will want to make a referral to a GI doc for an endoscopy with biopsy of the small bowel lining to confirm the positive anti-tissue transglutaminase tTG? IGG? result. Make sure your daughter doesn't begin cutting back on gluten until all testing is done.

Edited September 23, 2023 by trents

[Rachy265]

Thank you both for all the advice. I'll let you know if we get any further info about the nature of the blood tests.

[Rachy265]

Just a quick update regarding the confusion over the anti-tissue transglutaminase test results. I think the "tTg IgA to follow" must have been a typo as the follow-up test was an IgA endomysial antibody test which came back weakly positive. She's now being referred on to a Gastroenterologist.

[trents]

2 hours ago, Rachy265 said:

Just a quick update regarding the confusion over the anti-tissue transglutaminase test results. I think the "tTg IgA to follow" must have been a typo as the follow-up test was an IgA endomysial antibody test which came back weakly positive. She's now being referred on to a Gastroenterologist.

Thank you for the update. I don't think I've ever heard of a "weakly" positive EMA. They're usually just positive or negative. But the EMA is very specific for celiac disease.