SIDEROPENIC ANEMIA AND CELIAC-DISEASE - ONE STUDY, 2 POINTS-OF-VIEW

Recent studies have pointed to the relationship between iron deficienc y anemia and celiac, disease, although data on the prevalence of celia c disease in anemic patients have been conflicting, and there is no ag reement on the best screening procedure for CD in these patients. Our aims were to evaluate the relationship between anemia and celiac disea se (CD) from two different points of view-the hematology clinic and th e pediatric gastroenterology department-and to evaluate the utility of anti-endomysial antibody determination in screening anemic patients f or CD using human umbilical cord as substrate. We studied 130 patients with CD (58 males, 72 females; median age 18 months) diagnosed at a d epartment of Pediatric Gastroenterology, and 85 patients with iron def iciency anemia (38 males, 47 females; median age 48 years) observed at a hematology outpatient Clinic. From the 85 adult patients with iron deficiency anemia, we selected a subgroup of 25 subjects with no impro vement in Hb after two months of iron therapy (80 mg/day orally). Rout ine hematochemical tests were performed in all 215 patients. All pedia tric and adult subjects underwent immunological screening for celiac d isease (AGA and EmA assay); intestinal biopsy was also performed on pa tients testing positive. In the adult anemic patients a serum sample w as stored at -20 degrees C on first observation, and after 6-18 months EmA on human umbilical cord were assayed. In the pediatric patients w ith CD, anemia was observed in 91/130 patients (70% of cases, the most frequent symptom after poor growth); however, this was the only prese nting symptom of CD in 2/130 patients (1.5% of cases). Anemia was side ropenic in 41/91 patients (iron <45 mu g/dl, ferritin <15 mu g/liter). In the adult patients with iron deficiency anemia, immunological scre ening (AGA and EmA) showed suspected CD in 5/85 cases (5.8%), with dia gnosis confirmed on intestinal biopsy. These five patients were in the subgroup of iron supplementation therapy nonresponders. CD prevalence in the refractory anemia subgroup was, therefore, 5/25 (20%). On diag nosis the hematological indices of the anemia + CD patients were not d ifferent than those of the refractory anemia patients without CD. The median age of the CD + anemia patients was significantly lower than th at of the whole group of anemic subjects, and there was also a prevale nce of females (4/5 cases). The results of the EmA determination on hu man umbilical cord in the adult anemic patients showed a perfect conco rdance with those using a traditional kit that uses monkey esophagus a s substrate. In the pediatric age group many cases of CD with anemia a s the only sign of the disease are probably not diagnosed. In our adul t patients with sideropenic anemia, CD prevalence was 5-6%; however, t he observation of anemic patients not responding to oral iron therapy makes a diagnosis of CD much more probable. EmA determination on human umbilical cord is the most logical approach to screen anemic patients for suspected CD.