Anaemia linked to coeliac disease

Q. As a physician, I've had several patients come to me with anaemia not resolving with iron tablets, and referred by their GPs for endoscopy to rule out diseases such as cancer. I've scoped them and found they have had undiagnosed coeliac disease. Please let your readers know that coeliac disease can be a cause of anaemia, and one that often won't respond to iron tablets. - Dr S, Tauranga
A. Coeliac disease is a malabsorption disorder of the small intestine. Under a microscope, the lining of one's small intestine looks like the surface of a shag carpet, covered in countless loops of cells providing 200sq m of surface area for absorbing nutrients, roughly the same size as a tennis court.
If you have coeliac disease, this shag carpet looks more like a linoleum floor, flat and bare, unable to absorb much of anything. In severe cases, patients are stricken with weight loss, malnutrition, and diarrhoea. Milder cases may present with only fatigue, or vitamin and mineral deficiencies, such as the above.
Iron is usually processed in the stomach and absorbed in the small intestine. In coeliac disease it can pass unabsorbed into the stool. Iron is a key component in making red blood cells, which carry oxygen to all our tissues. The result of iron malabsorption can be an iron-deficiency anaemia. A GP would pick this up either on a routine blood count obtained for some other reason, or when prompted by symptoms of lightheadedness, fatigue or shortness of breath.
Cases of iron-deficiency anaemia can be caused by heavy menstrual periods, chronic illness, kidney disease, gastrointestinal tumours, or processes such as coeliac disease.
Testing for coeliac disease is based on blood tests and sometimes confirmed with endoscopy. Treatment centres on the complete avoidance of gliadin, a gluten protein present in foods like wheat and barley. In the short term, the anaemia can be treated with intravenous iron infusions. With time the intestine heals itself, oral iron is once again absorbed, and the anaemia corrects itself. Thanks for sharing this, Dr S.
Gary Payinda MD is an emergency medicine consultant in Whangarei.
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(This column provides general information and is not a substitute for the medical advice of your personal doctor.)