title: Anemia in Pediatric Celiac Disease: Association With Clinical and Histological Features and Response to Gluten-free Diet.
abstract: The aim of the present study was to compare clinical, serological, and histological manifestations between children with anemia and without anemia at celiac disease (CD) diagnosis.
  
  
  
  Despite being a common finding, the association between the presence of anemia and clinicohistopathological presentation of CD in children remains obscure.
  
  
  
  A total of 455 patients with CD <18 years of age were divided into those with anemia and those without anemia at diagnosis. The groups underwent comparisons of a variety of clinical, serological, and laboratory parameters and severity of small-bowel mucosal damage. Furthermore, adherence and clinical and serological response to the gluten-free diet (GFD) were compared.
  
  
  
  Anemia was detected in 18.0% of the patients. Children with anemia had higher values for transglutaminase 2 antibodies (120.0 U/L vs 88.0 U/L, P < 0.001) and, by definition, lower values for hemoglobin (10.5 g/dL vs 12.8 g/dL, P < 0.001) and other iron parameters. They were also less often screen-detected (13.4% vs 34.6%), had more severe histological damage (P = 0.048), and poorer dietary adherence (78.3% vs 87.5%, P = 0.035) than the patients without anemia. A total of 92% of the patients recovered from anemia after a median of 1 year on a GFD, but hemoglobin values remained significantly lower compared with the nonanemic group (12.5 g/dL vs 13.2 g/dL, P = 0.045). There was no difference between the groups in the clinical and serological response to the GFD (P = 0.318).
  
  
  
  Anemia at CD diagnosis is associated with more severe histological and serological presentation in children. Furthermore, low hemoglobin may not fully recover even after a median of 1 year on a strict GFD.
authors.affiliation: *Tampere Center for Child Health Research, Tampere University Hospital †School of Health Sciences, University of Tampere ‡Department of Internal Medicine, Tampere University Hospital and University of Tampere, Tampere, Finland.
authors.forename: Teemu
authors.initials: T
authors.lastname: Rajalahti
authors.forename: Marleena
authors.initials: M
authors.lastname: Repo
authors.forename: Laura
authors.initials: L
authors.lastname: Kivelä
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.forename: Katri
authors.initials: K
authors.lastname: Lindfors
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D000906:Antibodies / Q000097:blood; D002446:Celiac Disease / Q000097:blood / Q000150:complications* / Q000178:diet therapy / Q000473:pathology; D002648:Child; D055050:Diet, Gluten-Free; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D010349:Patient Compliance; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D000906:Antibodies; D006454:Hemoglobins; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins