Published online 24 September 2008
Haematologica, Vol 93, Issue 12, 1785-1791 doi:10.3324/haematol.13255
Copyright © 2008 by Ferrata Storti Foundation

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Bergamaschi, G. Articles by Corazza, G. R. Search for Related Content PubMed PubMed Citation Articles by Bergamaschi, G. Articles by Corazza, G. R.

Anemia of Chronic Disease

Anemia of chronic disease and defective erythropoietin production in patients with celiac disease

Gaetano Bergamaschi, Konstantinos Markopoulos, Riccardo Albertini, Antonio Di Sabatino, Federico Biagi, Rachele Ciccocioppo, Eloisa Arbustini, Gino Roberto Corazza

Department of Internal Medicine, University of Pavia Medical School and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

Correspondence: Gaetano Bergamaschi, MD, Department of Internal Medicine, Policlinico San Matteo, Piazzale Golgi, 27100, Pavia, Italy. E-mail:n.bergamaschi{at}smatteo.pv.it

Background: Anemia due to hematinic deficiencies is common in patients with untreated celiac disease. Although celiac disease is a chronic condition characterized by an intense inflammatory response of the intestinal mucosa, scant data are available about the prevalence of anemia of chronic disease in celiac disease.

Design and Methods: One hundred and fifty-two patients with celiac disease at presentation were studied. Anemia was investigated by determining complete blood counts, body iron status, serum levels of the soluble transferrin receptor, erythropoietin, prohepcidin and interferon-. Genotyping for HFE mutations associated with hereditary hemochromatosis was performed. Fifty-three anemic patients were re-evaluated for hematologic response after 1 year on a gluten-free diet.

Results: At the time of diagnosis of celiac disease the prevalence of anemia was 34%. Fifty-three out of 65 anemic patients had either iron and/or vitamin deficiency (folate, vitamin B₁₂). Hereditary hemochromatosis mutations did not affect the prevalence of anemia. In 11 cases iron status parameters were indicative of anemia of chronic disease, sometimes in association with iron deficiency (6 patients). Patients with anemia of chronic disease had low levels of erythropoietin for the degree of anemia and increased serum interferon-. In most cases anemia improved following a gluten-free diet, response rates being similar in anemia of chronic disease and in anemia due to hematinic deficiencies.

Conclusions: Our study shows that, in addition to iron and vitamin deficiencies, anemia of chronic disease has a significant role in some patients with celiac disease. Suppression of intestinal inflammatory changes as a result of a gluten-free diet improves anemia by correcting iron and vitamin malabsorption as well as mechanisms contributing to anemia of chronic disease.

Key words: celiac disease, iron deficiency anemia, inflammation.

This article has been cited by other articles:

				G. Bergamaschi, A. Di Sabatino, R. Albertini, S. Ardizzone, P. Biancheri, E. Bonetti, A. Cassinotti, P. Cazzola, K. Markopoulos, A. Massari, et al. Prevalence and pathogenesis of anemia in inflammatory bowel disease. Influence of anti-tumor necrosis factor-{alpha} treatment Haematologica, February 1, 2010; 95(2): 199 - 205. [Abstract] [Full Text] [PDF]

				M. Cazzola Flow cytometry immunophenotyping for diagnosis of myelodysplastic syndrome Haematologica, August 1, 2009; 94(8): 1041 - 1043. [Full Text] [PDF]

				C. Hershko and J. Patz Ironing out the mechanism of anemia in celiac disease Haematologica, December 1, 2008; 93(12): 1761 - 1765. [Full Text] [PDF]