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CD-Skills – Case report, Medical University Graz, Austria

19. February 2021.

Patient’s history:

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):

Erythrocytes4.41 10^12/L 4.10-5.10
Haemoglobin7.3 ; TI/- g/dL12.0-15.3
Haematocrit27.4/- %35.0-45.0
MCV62.1/– fL80.0-98.0
MCH16.6/- pg28.0-33.0
MCHC26.6/- g/dL33.0-36.0
Iron
Iron27/- μg/dL50.0-160.0
Transferrin3.740/+ g/L2.000-3.600
Transferrin saturation5/- %16-45
Ferritin7 ng/mL4-114

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):

IgA1.41 g/L0.61-3.48
Transglutaminase-antibiotied, IgA360/+++ U/mL0-16
Endomysium-antibodies1:10 +++ 

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.

 

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    CD-Skills – Case report, Medical University Graz, Austria

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    • → Focus IN CD
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    • → University Medical Centre Maribor
    • → Medical University of Graz
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    • → University Children's Hospital Tiršova
    • → General University Hospital in Prague
    • → “Nicolae Testemitanu” State University of Medicine and Pharmacy of the Republic of Moldova, Kishinau
    • → LMU Klinikum