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OBJECTIVE: To analyze the hematological manifestations among celiac disease (CD) and CD with type-1 diabetes mellitus (T1DM) children to aid in differential diagnosis and management of disease.
METHODS: This study was conducted at Institute of Biotechnology and Genetic Engineering, University of Sindh, Jamshoro, Pakistan. CD pediatric patients were diagnosed through serological or intestinal biopsy. The individuals were divided into 5 groups (35 each); Control (A), diagnosed cases of CD (B), individuals affected with celiac-like indications (C), T1DM patients with celiac-like symptoms (D) and T1DM patients (E).
RESULTS: Mean age of 175 participants was 9.5±1.2 years. Mean hemoglobin level (mg/dl) was 9.1±1.1, 9.03±1.4, 8.64±1.2 and 11.7±1.3 in group-B, group-C, group-D and group-E respectively as compared to 13.02±1.5 in Group-A (p<0.001). Mean corpuscular volume (MCV) [fl] was 64.1±5.4, 68.5±7.8, 57.6±6.0 and 69.4±4.4 in group-B, group-C, group-D and group-E respectively as compared to 84.4±7.3 in Group-A (p<0.001). Mean corpuscular hemoglobin (MCH) [group-B: 24.1pg, group-C: 25.5pg, group-D: 24.6pg] and mean corpuscular hemoglobin concentration (MCHC) [group-B: 29.3 g/dl, group-C: 277.9 g/dl, group-D: 31.5 g/dl] were decreased among all celiac affected cases. For group-E the hemoglobin, MCV and MCHC were in the normal ranges. Platelet Count (cells/ul) was 689±178x103, 702±141x103, 518±124x103 and 529±101x103 in group-B, group-C, group-D & group-E respectively as compared to 326±98x103 in group A (p<0.01). Mean Transferrin levels (mg/dl) were 411.5±24.8; 387.7±22.4; 406.4±21.4 & 368.8±22.0 in group-B, group-C, group-D and group-E and 271.1±39.1 in group-A (p<0.01).
CONCLUSION: Hematological anomalies; like anemia and thrombocytosis are frequently present in mismanaged and late diagnosed CD children.
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2. Khatoon S, Ahmed A, Yousaf S. Iron deficiency anemia in pakistan: celiac disease an underlying cause. J Ayub Med Coll Abbottabad 2018;30(3):372-6.
3. Rwalah M, Kamal N, Hijazeen R, Ghanma A, Alzeben Z, D'ajeh R. Hematological findings among Jordanian children with celiac disease at presentation: a retrospective analytical study. J Royal Med Serv 2014;102(1326):1-6. DOI: 10.12816/0008059.
4. Albrady A, Alharbi F, Almutairi A, Alhujaylan M, Almutiri N, Aljarallah B. Clinical Profile of Celiac Disease: Patient Epidemiological Prospective. Ann Med Health Sci Res 2018;8.
5. Riddle MS, Murray JA, Porter CK. The incidence and risk of celiac disease in a healthy US adult population. Am J Gastroenterol 2012;107(8):1248-55. DOI: 10.1038/ajg.2012.130.
6. Jamali AA, Shaikh B, Jamali AA, Jamali GM, Kanhar IA, Tanwani BM. Chronic diarreha: frequency of celiac disease in childerns at teatiary care hospital. Indo Am J Pharmaceutical Sci 2018;5(4):2252-9.
7. Rashid M, Khan AG. Celiac disease in Pakistan: challenges and opportunities. J Ayub Med Coll Abbottabad 2009;21(3):1-2.
8. Green PH. Where are all those patients with Celiac disease? Am J Gastroenterol 2007 Jul;102(7):1461-3. DOI: 10.1111/j.1572-0241.2007.01167.x.
9. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J 2019 Jun;7(5):583-613. DOI: 10.1177/2050640619844125.
10. Ludvigsson J, Bai J, Biagi F, Card TR, Ciacci C, Ciclitira PJ, et al. BSG Coeliac Disease Guidelines Development Group; British Society of Gastroenterology. Diagnosis and management of adultcoeliacdisease: guidelines from the British Society of Gastroenterology. Gut 2014;63(8):1210-28. DOI: 10.1136/gutjnl-2013-306578.
11. Farrell RJ, Kelly CP. Celiac sprue. N Engl J Med 2002;346(3):180-8. DOI: 10.1056/NEJMra010852.
12. Fisgin T, Yarali N, Duru F, Usta B, Kara A. Hematologic manifestation of childhood celiac disease. Acta Haematol 2004;111(4):211-4. DOI: 10.1159/000077568.
13. Balaban DV, Popp A, Ionita Radu F, Jinga M. Hematologic Manifestations in Celiac Disease—A Practical Review. Medicina (Kaunas) 2019;55(7):373. DOI: 10.3390/medicina55070373.
14. Mäki M, Mustalahti K, Kokkonen J, Kulmala P, Haapalahti M, Karttunen T, et al. Prevalence of celiac disease among children in Finland. N Engl J Med 2003 Jun 19;348(25):2517-24. DOI: 10.1056/NEJMoa021687.
15. Rolfsen M, Lodhia N. Atypical Presentation of Celiac Disease: 2182. Am J Gastroenterol 2016;111:pS1043.
16. Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, et al. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol 2001 Jan;96(1):126-31. DOI: 10.1111/j.1572-0241.2001.03462.x.
17. Chen CM, Mu SC, Shih CK, Chen YL, Tsai LY, Kuo YT, et al. Iron status of infants in the first year of life in northern Taiwan. Nutrients 2020;12(1):139. DOI: 10.3390/nu12010139.
18. Sanseviero MT, Mazza GA, Pullano MN, Oliveiro AC, Altomare F, Pedrelli L, et al. Iron deficiency anemia in newly diagnosed celiac disease in children. Minerva Pediatr 2016;68(1):1-4.
19. Radlović N, Leković Z, Mladenović M, Radlović V, Vuletić B, Ducic S, et al. Frequency, severity and type of anemia in children with classical celiac disease. Srp Arh Celok Lek 2019;147(3-4):189-92. DOI: 10.2298/SARH181203021R.
20. Halfdanarson TR, Litzow MR, Murray JA. Hematologic manifestations of celiac disease. Blood 2007;109(2):412-21. DOI: 10.1182/blood-2006-07-031104.
21. DAN K. Thrombocytosis in iron deficiency anemia. Intern Med 2005;44(10):1025-6.
22. Carroccio A, Giannitrapani L, Di Prima L, Iannitto E, Montalto G, Notarbartolo A. Extreme thrombocytosis as a sign of coeliac disease in the elderly: case report. Eur J Gastroenterol Hepatol 2002 Aug;14(8):897-900. DOI: 10.1097/00042737-200208000-00017.
23. Fasano A. Celiac disease--how to handle a clinical chameleon. N Engl J Med 2003 Jun 19;348(25):2568-70. DOI: 10.1056/NEJMe030050.
24. Kawabata H. Transferrin and transferrin receptors update. Free Radic Biol Med 2019 Mar;133:46-54. DOI: 10.1016/j.freeradbiomed.2018.06.037.
25. Litchford MD. Nutritional issues in the patient with diabetes and foot ulcers. In Levin and O'Neal's The Diabetic Foot: Elsevier; 2008:199-217.
26. Spijkerman M, Tan IL, Kolkman JJ, Withoff S, Wijmenga C, Visschedijk MC,et al. A large variety of clinical features and concomitant disorders in celiac disease–A cohort study in the Netherlands. Dig Liver Dis 2016 May;48(5):499-505. DOI: 10.1016/j.dld.2016.01.006.
27. Rasheed J, Khan T, Khalid M, Zafar F. celiac disease: a medley of clinical features a tertiary care hospital experience. Prof Med J 2018;25(5):p669-75.
28. Işikay S, Hizli Ş, Yilmaz K. Prevalence of celiac disease in Turkish children with idiopathic epilepsy. Iran J Pediatr 2014;24(3):280-4.
29. Jansson L. The regulation of pancreatic islet blood flow. Diabetes Metab Rev 1994;10(4):407-16. DOI: 10.1002/dmr.5610100405.