Immune Thrombocytopenia in Adult Celiac Disease

Hugh James Freeman^1,

¹Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada

Cite this paper:
Hugh James Freeman. Immune Thrombocytopenia in Adult Celiac Disease. International Journal of Celiac Disease. 2018; 6(1):30-32. doi: 10.12691/ijcd-6-1-7

Abstract

Celiac disease has been associated with a number of immune-mediated hematologic disorders, including idiopathic or immune thrombocytopenic purpura (ITP). Review of the literature suggests that children are particularly affected, often with overt skin findings, but in this report, a 39-yr old male with biopsy-defined celiac disease was detected with a persistent immune-mediated reduction in his platelet count despite treatment and follow-up for more than a decade. Although the celiac disease resolved with a strict gluten-free diet, there was no effect on the ITP. Experience suggests that ITP may be rarely appreciated in adults (compared to children) because it may be limited in severity and occurs without clinically obvious purpura or evidence of bleeding, even with diagnostic or therapeutic biopsy procedures. A subsequent retrospective review of over 300 celiac disease patient records from a single teaching hospital clinical practice experience spanning almost 40 years confirmed no additional cases of thrombocytopenia. ITP appears to be rarely associated with celiac disease in adults and, in spite of resolution of the enteropathy, did not appear to respond to a gluten-free diet, even after more than a decade of dietary treatment.

Keywords:
platelets immune thrombocytopenia idiopathic or immune thrombocytopenic purpura (ITP) adult celiac disease

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Freeman HJ. Celiac Disease 2017. Reference Module in Biomedical Sciences. Elsevier. 6- Dec-17.
[2]	Stene-Larsen G, Mosvold J, Ly B. Selective vitamin B12 malabsorption in adult celiac disease. Report on three cases with associated autoimmune diseases. Scand J Gastroenterol 1988; 23: 1105-1108.
[3]	Stenhammar L, Ljunggren CG. Thrombocytopenic purpura and celiac disease. Acta Pediatr Scand 1988; 77: 764-766.
[4]	Sarbay H, Sarbay BC, Akin M, Kocamaz H, Tosun MS. Celiac disease presenting with immune thrombocytopenia purpura. Case Rep Hematol 2017; Article ID 6341321.
[5]	Halfdanarson TR, Kumar N, Hogan WJ, Murray JA. Copper deficiency in celiac disease. J Clin Gastroenterol 2009; 43: 162-164.
[6]	Dogan M, Sal E, Akbayram S, Peker E, Cesur Y, Oner AF. Concurrent celiac disease, idiopathic thrombocytopenia purpura and autoimmune thyroiditis: a case report. Clin App Thromb Hemost 2011; 17: E13-E16.
[7]	Hammami S, Haddad S, Lajmi K, Besbes LG, Meriem CB, Chouchane S, Guediche MN. Immune thrombocytopenia purpura and celiac disease. J Pediatr Child Health 2011; 47: 240.
[8]	Fisgin T, Yerali N, Duru F, Usta B, Kara A. Hematologic manifestation of childhood celiac disease. Acta Hematol 2014; 111: 211-214.
[9]	Bansal D, Trehan A, Gupta MK, Varma N, Marwaha RK. Serodiagnosis of celiac disease in children referred for evaluation of anemia: a paediatric hematology unit’s experience. Indian J Pathol Microbiol 2011; 54: 756-760.
[10]	Sarbay H, Kocamaz H, Akin M, Ozhan B. Investigation of celiac disease followed by immune thrombocytopenia purpura diagnosis in patients and comparison with literature. North Clin Istanb 2017; 4: 160-164.
[11]	Olen O, Montgomery SM, Elinder G, Ekbom A, Ludvigsson JF. Increased risk of immune thrombocytopenia purport among inpatients with celiac disease. Scand J Gastroenterol 2008; 43: 416-422.