An adolescent female was admitted with severe pneumonia, complicated by pulmonal embolism.
While both her family history and her own previous history were uneventful (= no history for any autoimmune disorders nor any chronic gastrointestinal, hepatic, respiratory nor neurological disease), her very pronounced iron deficiency anaemia was of concern (please see the original below):
|Haemoglobin||7.3 ; TI/- g/dL||12.0-15.3|
|Transferrin saturation||5/- %||16-45|
Careful history taking revealed that the patient was in regular control by the gynaecologist with normal results and there were no hints to any chronic and / or occult blood loss.
The patient’s diet consisted of a normal mixed diet including meat and chicken, in fact the girl was fond of steaks.
In consequence, coeliac serology was ordered in a timely manner by the attending physician, even including the request for HLA-typing:
The first results of coeliac serology were as follows (copy of the original):
|Transglutaminase-antibiotied, IgA||360/+++ U/mL||0-16|
During her stay as an inpatient lasting 3 weeks in total, celiac specific serology was repeated and results of HLA-typing received.
When being discharged, the patient received her diagnosis of Celiac Disease according to the current ESPGHAN guidelines, as follows:
I) Highly suspicious symptom/finding: Iron deficiency anaemia (no obvious other causes)
II) Repetitive positive results of tTG-AB >> 10 times the upper limit of our test’s range
III) Repetitive positivity of EMA-Abs
And: In addition we received her HLA-type as being is associated with Celiac Disease.
The patient was already started on a strictly gluten free diet upon individual counselling and tolerates this die very well.
Conclusion: Even when treating a patient for an acute and severe disease regarding as in this case an organ system beyond the GI-tract, the ordering of coeliac disease-specific diagnostics upon a “CD-leading symptom” (iron deficiency anaemia w/o other explanation) was very straightforward and attributable to the ordering physician (not a Paed Gastroenterologist) being well informed.