title: Anemia in celiac disease is multifactorial in etiology.
abstract: Anemia in celiac disease (CD) has been attributed to nutritional deficiencies; however, the clinical manifestations of CD have changed with nongastrointestinal presentations predominating. We collected hematologic parameters from a cohort of patients seen at a tertiary care center for CD to assess the characteristics of anemia in this population. Hematological parameters measured <or=3 months of diagnosis and degree of villous atrophy from 405 patients diagnosed >1995 was analyzed. Ferritin levels were compared with population controls (NHANES III). Iron deficiency was common, occurring in 33% of men and 19% of women (P < 0.001). Folate deficiency was seen in approximately 12% of the total sample and B12 deficiency in approximately 5%. Anemia was present in approximately 20% of the cohort. Among the anemic patients, ferritin was less than the 10th percentile in 45%, between the 10th and 50th percentile in 39% and greater than the 50th percentile in 13%. Ferritin > 50th percentile was more common in anemic men (24%) than in anemic women (9%; P > 0.20). Macrocytic anemia with concurrent B12 or folate deficiency was rare (3%). Elevated ESR was observed in patients with ferritin < 10th percentile and >50th. A gluten-free diet resulted in increased serum ferritin in iron-deficient patients, and decreased ferritin levels in those with high ferritin (r(2) = 0.46, P < 0.001). Although anemia is still a common presentation of celiac disease, nutritional deficiencies alone do not explain this phenomenon in all cases; inflammation appears to contribute as evidenced by the presence of anemia of chronic disease in some individuals.
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Harper
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Holleran
authors.forename: Rajasehkar
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology*; D018798:Anemia, Iron-Deficiency / Q000150:complications; D001799:Blood Sedimentation; D002446:Celiac Disease / Q000097:blood* / Q000150:complications* / Q000178:diet therapy; D015331:Cohort Studies; D005260:Female; D005293:Ferritins / Q000097:blood*; D005494:Folic Acid Deficiency / Q000150:complications; D006801:Humans; D007249:Inflammation / Q000150:complications; D008297:Male; D008875:Middle Aged; D014806:Vitamin B 12 Deficiency / Q000150:complications
chemical_list: D005293:Ferritins