Study of iron deficiency conditions in patients with gluten-related disorders who are on a gluten-free diet

Abstract

Background. Iron deficiency anemia (IDA) is the most common extraintestinal symptom of celiac disease in adults. Stu­dies of the presence or absence of iron deficiency, including cases of latent anemia, in patients with both celiac disease and non-celiac gluten sensitivity (NCGS) has not been previously carried out in our country. The purpose was to study and analyze general clinical and biochemical blood parameters of patients who are on a gluten-free diet with regards to the pre­sence of anemia and/or iron deficiency. Materials and methods. The study included 38 adults previously diagnosed with one of the major types of cereal intolerance — celiac disease or NCGS. All of them were on a gluten-free diet. The following hematological parameters were studied and analyzed for each subject: erythrocyte count, hemoglobin, ferritin, total iron-binding capacity, iron, and blood transferrin levels. Results. The analysis revealed that 13.16 % of 38 patients had mild IDA as measured by hemoglobin levels, and latent iron deficiency was found in 18.42 % patients. In general, analysis of serum ferritin concentrations revealed the rate of iron deficiency of 31.58 % despite follo­wing a gluten-free diet for 6.5 (interquartile range of 4–12) years, suggesting that the rate of all iron deficiency cases (including the latent ones) almost twice exceeds the rate of IDA detected by hemoglobin analysis. Withal, the red blood cell count was normal in 100 % of the examined people, but a decrease in the concentration of serum iron in the blood was observed in 23.08 % of patients. Among individuals with iron deficiency, people with celiac disease are more likely to be found than those with NCGS (83.3 and 16.7 %, respectively). Conclusions. Patients with celiac disease and NCGS remain at risk for the deve­lopment of IDA despite following a gluten-free diet. The isolated indicator of red blood cells is not informative for the diagnosis of not only latent iron deficiency but IDA as well. Isolated serum iron levels are also not indicative for the diagnosis of these conditions. In this regard, ferritin becomes the most significant marker of iron deficiency. Thus, it is necessary to carefully monitor this group of patients to identify latent forms of nutritional deficiency, in particular, iron deficiency, and to carry out the well-grounded individualized correction of their consequences.

Keywords

• celiac disease
• non-celiac gluten sensitivity
• iron deficiency anemia
• latent iron deficiency