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.