Hematologic manifestations of celiac disease

Abstract

Celiac disease is a common systemic disorder that can have multiple hematologic manifestations. Patients with celiac disease may present to hematologists for evaluation of various hematologic problems prior to receiving a diagnosis of celiac disease. Anemia secondary to malabsorption of iron, folic acid, and/or vitamin B12 is a common complication of celiac disease and many patients have anemia at the time of diagnosis. Celiac disease may also be associated with thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and IgA deficiency. Patients with celiac disease are at increased risk of being diagnosed with lymphoma, especially of the T-cell type. The risk is highest for enteropathy-type T-cell lymphoma (ETL) and B-cell lymphoma of the gut, but extraintestinal lymphomas can also be seen. ETL is an aggressive disease with poor prognosis, but strict adherence to a gluten-free diet may prevent its occurrence.

Figure 1

Diagnosis of celiac disease.

Figure 2

Blood smear showing characteristic findings of hyposplenism such as Howell-Jolly bodies, acanthocytes, and target cells. Image was observed using an Olympus Provis AX70 microscope equipped with an Olympus PlanApo 60 ×/1.40 numerical aperture oil objective (Olympus, Tokyo, Japan). Resolve high-viscosity immersion oil was used as imaging medium, and cells were stained with Wright-Giemsa. Image was acquired using a Nikon DXM 1200 digital camera and Nikon ACT-1 software version 2.62 (Nikon, Melville, NY).