title: Serodiagnosis of celiac disease in children referred for evaluation of anemia: a pediatric hematology unit's experience.
abstract: BACKGROUND
  Children presenting with typical clinical features of celiac disease (CD) are diagnosed relatively easily, however, diagnosis remains challenging and is often delayed when they present with 'difficult to treat anemia' without overt gastrointestinal manifestations. Index study was undertaken to report profile of patients referred to pediatric hematology unit with 'difficult anemia' who subsequently were diagnosed with CD.
  
  
  METHODS
  The records of 83 patients (1988-2008) with CD were scrutinized retrospectively who had presented with predominant hematological manifestations.
  
  
  RESULTS
  CD was confirmed histologically in 31 (37%), while 52 (63%) were diagnosed by serology alone. The mean age at diagnosis was 8.0 ± 2.8 years. The mean duration of symptom-diagnosis interval was 40.9 ± 30.6 months. Eighty-one (98%) children had anemia (Hb < 11 g/dl) and 55 (66%) had received iron supplements without discernible benefit. Thirty-nine (47%) patients received a blood transfusion. Thirty-six (43%) patients did not have diarrhea. Majority of the patients had either a microcytic-hypochromic (48%) or dimorphic (43%) anemia. Twenty-four (33%) had thrombocytosis, while 5 (7%) had thrombocytopenia. Mean duration of follow-up for patients on roll in the clinic for more than six months was 17.7 ± 20.9 months.
  
  
  CONCLUSIONS
  Pediatricians and hematologists need to be aware of the extra-intestinal manifestations of CD. Prolonged duration of symptoms and a diagnosis at a relatively older age is striking in children presenting with predominantly hematological manifestations. Investigations for CD are recommended in children presenting with iron deficiency anemia refractory to hematinics or who have coexisting growth retardation. Necessity for biopsy in overtly symptomatic cases is discussed.
authors.affiliation: Pediatric Hematology-Oncology Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. deepakritu@yahoo.com
authors.forename: Deepak
authors.initials: D
authors.lastname: Bansal
authors.forename: Amita
authors.initials: A
authors.lastname: Trehan
authors.forename: Mukesh Kumar
authors.initials: MK
authors.lastname: Gupta
authors.forename: Neelam
authors.initials: N
authors.lastname: Varma
authors.forename: R K
authors.initials: RK
authors.lastname: Marwaha
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000175:diagnosis* / Q000209:etiology*; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012698:Serologic Tests