HEMATOLOGICAL MANIFESTATIONS OF CELIAC DISEASE AMONG CHILDREN: A SINGLE CENTER STUDY FROM SOUTH PUNJAB, PAKISTAN

Main Article Content

Saima Jabeen Joya
Muhammad Tariq Aziz
Hassan Suleman
Muhammad Abu Talib
Ibrar Hussain
Ghazi Khan Khosa

Abstract

OBJECTIVE: To find out various hematological manifestations among children from South Punjab, having confirmed celiac disease (CD).


METHODS:  This case-control study was done at The Institute of Child Health, Multan, Pakistan, from 1st February 2019 to 31st July 2019. We enrolled 139 children having CD, ranging in age from 1-12 years. An equal number of age and gender matched controls were also enrolled. Haematological parameters were compared between cases and controls.


RESULTS:    Majority (n=83/139; 59.7%) of children with CD were male. Mean age was 8.78±2.4 years. The common hematological manifestations among children with CD were anemia (n=127; 91.4%), thrombocytosis (n=104; 74.8%); leucopenia (n=10; 7.2%) and coagulopathy (n=13; 9.4%). Anemia alone was present in 20 (14.4%) children, anemia plus thrombocytosis in 91 (65.5%) cases, anemia plus leucopenia in 7 (5.0%) cases and anemia along with thrombocytosis and coagulopathy in 9 (6.5%) cases. Out of 127 cases of anemia, iron deficiency anemia (IDA) was noted in 96 (75.6%) cases, vitamin B12 and folate deficiency anemia in 14 (10.1%) cases whereas double deficiency anemia was seen in 17 (13.4%) cases. According to Modified Marsh Scoring, majority (n=46; 33.1%) of children had Type 3a CD. When compared to controls, CD cases had significantly lower haemoglobin, raised platelet count, lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) levels (p value<0.0001).


CONCLUSION: In children having CD, hematological manifestations are common. IDA is the most frequent hematological abnormality observed along with thrombocytosis in children with CD. Hematological parameters were significantly impaired among children with CD.

Article Details

How to Cite
Joya, S., M. Aziz, H. Suleman, M. Talib, I. Hussain, and G. Khosa. “HEMATOLOGICAL MANIFESTATIONS OF CELIAC DISEASE AMONG CHILDREN: A SINGLE CENTER STUDY FROM SOUTH PUNJAB, PAKISTAN”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 13, no. 1, Mar. 2021, pp. 43-6, doi:10.35845/kmuj.2021.20843.
Section
Original Articles

References

1. Tye-Din JA, Galipeau HJ, Agardh D. Celiac Disease: A review of current concepts in pathogenesis, prevention, and novel therapies. Front Pediatr 2018;6:350. DOI: 10.3389/fped.2018.00350.
2. Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Konickx C, et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr 2020;70(1):141-56. DOI: 10.1097/MPG.0000000000002497.
3. Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16:823–36. DOI: 10.1016/j.cgh.2017.06.037.
4. Nardecchia S, Auricchio R, Discepolo V, Troncone R. Extra-intestinal manifestations of coeliac disease in children: clinical features and mechanisms. Front Pediatr 2019;7:56. DOI: 10.3389/fped.2019.00056.
5. Kamboj AK, Oxentenko AS. Clinical and histologic mimickers of celiac disease. Clin Transl Gastroenterol. 2017;8(8):e114. DOI:10.1038/ctg.2017.41.
6. Freeman HJ. Lymphoproliferative and intestinal malignancies in 214 patients with biopsy-defined celiac disease. J Clin Gastroenterol 2004;38:429-34. DOI: 10.1097/00004836-200405000-00008.
7. Csizmadia CG, Mearin ML, von Blomberg BM, Brand R, Verloove-Vanhorick SP. An iceberg of childhood coeliac disease in the Netherlands. Lancet 1999;353:813-4. DOI: 10.1016/s0140-6736(99)00243-3.
8. Maki 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;348:2517-24. DOI: 10.1056/nejmoa021687.
9. Catassi C, Rätsch IM, Fabiani E, Rossini M, Bordicchia F, Candela F, et al. Coeliac disease in the year 2000: exploring the iceberg. Lancet 1994;343:200-3. DOI: 10.1016/s0140-6736(94)90989-x.
10. Mantegazza C, Zuccotti G, Dilillo D, Koglmeier J. Celiac Disease in Children: A Review. Int J Dig Dis 2015;1(19):1-7. DOI: 10.4172/2472-1891.100009.
11. Aziz S, Muzaffar R, Zafar MN, Mehnaz A, Mubarak M, Abbas Z, et al. Celiac disease in children with persistent diarrhea and failure to thrive. J Coll Physicians Surg Pak 2007;17:554-7.
12. Halfdanarson TR, Litzow MR, Murray JA. Hematologic manifestations of Celiac disease. Blood 2007;109:412-21. DOI: 10.1182/blood-2006-07-031104.
13. Rajalahti T, Repo M, Kivelä L, Huhtala H, Mäki M, Kaukinen K, et al. Anemia in pediatric celiac disease: association with clinical and histological features and response to gluten-free diet. J Pediatr Gastroenterol Nutr 2017;64(1):e1-e6. DOI: 10.1097/mpg.0000000000001221.
14. de Vizia B, Poggi V, Conenna R, Fiorillo A, Scippa L. Iron absorption and iron deficiency in infants and children with gastrointestinal diseases. J Pediatr Gastroenterol Nutr 1992;14:21–26. DOI: 10.1097/00005176-199201000-00005.
15. Madni B, Malhi KA, Rehman F, Shahnawaz K, Zahoor F, Mughal BB. Hematological manifestations of celiac disease in children. Med Forum 2019;30(6):6-9.
16. Nelson EW, Ertan A, Brooks FP, Cerda JJ. Thrombocytosis in patients with celiac sprue. Gastroenterology 1976;70:1042–4.
17. Patwari AK, Anand VK, Kapur G, Narayan S. Clinical and nutritional profile of children with celiac disease. Indian Pediatr 2003;40:337–42.
18. Schafer AI. Thrombocytosis. N Engl J Med 2004;350:1211–1219. DOI: 10.1056/nejmra035363.
19. Saqlain N, Ahmed N. Haematology of childhood celiac disease. Pak Pediatr J 2015;39(3):162-6.
20. 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.
21. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999;11:1185-1194. DOI: 10.1097/00042737-199910000-00019.