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JustMe75

Blood Test Questions

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I had negative blood work which I ignored and tried the gluten free diet anyway and I am so much better. But, I am reading the book "Celiac Disease a Hidden Epidemic" and he talks about the blood tests that are most accurtate. I can't tell if my doctor did them all. I hope you guys can help because my GP doctor doesn't know anything about Celiac and wouldn't even test me, I talked my allergist into doing theblood tests and I had to give him a list of the tests I read about on here. He said some of them the lab might not be able to do. I know it really doesn't matter but I am obsessive by nature and was just curious if they missed something.

Here are the tests they did:

TTG Antibody, IGA

Antigliadin Antibody panel (IGA)

Gliadin Antibody (IGG)

Immunoglobulin A

Immunoglobulin E

Those were all in the normal range.

He also tested for things like Lymphocytes, Eosinophils, Monocytes and they were just percentages without a "normal range" key. I had to call to get the results and have not seen the doctor since so I am assuming everything is normal.

Can you tell if he did all the tests needed to diagnose celiac?

**By the way this book is VERY interesting, I can't put it down!!

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He did one of the two most sensitive ones, the tTG, the total IgA (which, if low, would tell you if your negatives were potentially false negatives), and the AGA IgA and IgG. He did four out of the five. The only one that wasn't run was the EMA IgA.

From www.celiacdiseasecenter.columbia.edu

"Lack of concordance of endomysial antibody and anti-tTG

The discovery that the enzyme tissue transglutaminase (tTG) was the autoantigen for the endomysial antibody [20] prompted the development of ELISA testing for tTG. This allowed automation of the test for the detection of anti-tTG. The measurement of the EMA required a cumbersome, observer dependant immunoflourescence technique. As a result many laboratories have replaced the endomysial antibody with the anti-tTG test. However the test does not measure the same thing and there are differences in preparation of the antigen (tTG), either tTG from guinea pig liver or human tTG, preparation of the kits and cutoff values for each patient population. In addition there may be other antigens, apart from tTG , for the EMA [21]. The EMA is certainly the gold standard in the serologic diagnosis of celiac disease, for it is virtually 100% specific. However multiple cases have demonstrated that patients may be positive for one (either EMA or anti-tTG) and negative for the other, i.e. they lack 100% concordance [22-25]. As a result reliance on the anti-tTG as a single test will underestimate the presence of celiac disease and both the EMA and the anti-tTG should be performed."

You may or may not have Celiac, but if your dietary response is positive, it may be worth it to stay on the diet if your goal is to stop the symptoms. You could/couldn't have Celiac or you could have a non-Celiac gluten intolerance.

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If your total IgA (Immunoglobin A) was low, it would mean that the rest of your IgA tests could be false negatives. Basically, if you had a too low IgA, it means you aren't producing it, so when they do the other IgA tests, it could be false negatives (i.e., you have it, but aren't producing the antibodies to show you have it).

From the same page as above:

Selective IgA deficiency (SIgA deficiency)

SIgA deficiency occurs 10 to 15 times more commonly among people with celiac disease compared to the general population [19]. Patients with SIgA deficiency will lack IgA antibodies including endomysial antibody, tTG and IgA AGA. To detect celiac disease in patients with SIgA deficiency an IgG antibody, typically IgG AGA, needs to be performed together with total IgA level. Alternatively, one may screen with IgG anti- EMA or IgG anti-tTG, though these are not widely available. Typically the patient with celiac disease and SIgA deficiency will have a positive IgG AGA and absent total IgA level. This combination should prompt a biopsy, whereas an isolated positive IgG AGA would usually not.

However, you said it wasn't low, so its not a concern here.

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