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Anämie und schwere Thrombozytopenie bei Sprue

Anemia and Severe Thrombocytopenia in Celiac Disease

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Zusammenfassung

Hintergrund:

Die Diagnose Sprue wird seit der Einführung serologischer Testverfahren zunehmend häufiger gestellt, insbesondere bei Patienten mit überwiegend extraintestinaler Manifestation. Unter diesen sind Blutbildveränderungen weit verbreitet, die in allen Zellreihen auftreten können. Besonders häufig ist die Eisenmangelanämie, aber auch eine Thrombozytose oder Thrombozytopenie kann mit der Sprue assoziiert sein.

Fallbeschreibung:

Die Autoren berichten über eine Patientin, die ihnen mit Zeichen einer Malnutrition, makrozytären Anämie und ausgeprägten Thrombozytopenie vorgestellt wurde. Die Verdachtsdiagnose einer zugrundeliegenden Sprue ließ sich im Rahmen der weiteren Diagnostik histologisch sichern. Unter glutenfreier Diät und Folsäuresubstitution besserten sich die Beschwerden, und es kam zu einer raschen hämatologischen Rekonstitution.

Schlussfolgerung:

Ähnlich massive Mangelzustände wurden bisher fast ausschließlich bei Patienten mit erhöhtem Folsäurebedarf in der Schwangerschaft oder bei Intensivpatienten beobachtet. Bei Blutbildveränderungen sollte neben malignen Erkrankungen auch die Sprue differentialdiagnostisch bedacht werden, insbesondere wenn Zeichen der Malnutrition vorliegen.

Abstract

Background:

The frequency of diagnosis of celiac disease has increased since the introduction of serologic testing. The number of patients in whom extraintestinal symptoms reflect the initial manifestation is rising. Common symptoms are changes in blood counts, which can arise from changes in all cell lineages. Among these, iron deficiency anemia is very common, but also thrombocytosis and thrombocytopenia have been reported to manifest themselves within the framework of celiac disease.

Case Report:

The authors report on a patient with malnutrition, macrocytic anemia, and pronounced thrombocytopenia. Based on changes of peripheral blood smear and endoscopic result, celiac disease was suspected that could be confirmed by histology of duodenal biopsies. The thrombocytopenia was reversible after initiation of gluten-free diet and folic acid substitution. In addition, clinical symptoms resolved and hematologic reconstitution could be observed.

Conclusion:

Similar deficiencies have almost exclusively been observed in patients with increased folic acid requirements during pregnancy or inten- sive care. Celiac disease must be taken into consideration, if changes in blood counts occur associated with gastrointestinal symptoms.

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Literatur

  1. Dubé C, Rostom A, Sy R, et al. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology 2005;128:Suppl 1:S57–67.

    Article  PubMed  Google Scholar 

  2. Tischendorf JJW, Wopp K, Streetz KL, et al. The value of duodenal biopsy within routine upper endoscopy: a prospective study in 1000 patients. Z Gastroenterol 2008;46:771–5.

    Article  CAS  PubMed  Google Scholar 

  3. Leeds JS, Hopper AD, Sanders DS. Coeliac disease. Br Med Bull 2008;88:157–70.

    Article  CAS  PubMed  Google Scholar 

  4. Halfdanarson TR, Litzow MR, Murray JA. Hematologic manifestations of celiac disease. Blood 2007;109:412–21.

    Article  CAS  PubMed  Google Scholar 

  5. Stenhammar L, Ljunggren CG. Thrombocytopenic purpura and coeliac disease. Acta Paediatr Scand 1988;77:764–6.

    Article  CAS  PubMed  Google Scholar 

  6. Olén O, Montgomery SM, Elinder G et al. Increased risk of immune thrombocytopenic purpura among inpatients with coeliac disease. Scand J Gastroenterol 2008;43:416–22.

    Article  PubMed  Google Scholar 

  7. Herrmann W, Schorr H, Obeid R, Geisel J. Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians. Am J Clin Nutr 2003;78:131–6.

    CAS  PubMed  Google Scholar 

  8. Hartong SC, Steegers EA, Visser W. Hemolysis, elevated liver enzymes and low platelets during pregnancy due to vitamin B12 and folate deficiencies. Eur J Obstet Gynecol Reprod Biol 2007;131:241–2.

    Article  CAS  PubMed  Google Scholar 

  9. Geerlings SE, Rommes JH, van Toorn DW, et al. Acute folate deficiency in a critically ill patient. Neth J Med 1997;51:36–8.

    Article  CAS  PubMed  Google Scholar 

  10. Sarode R, Garewal G, Marwaha N, et al. Pancytopenia in nutritional megaloblastic anaemia. A study from north-west India. Trop Geogr Med 1989;41:331–6.

    CAS  PubMed  Google Scholar 

  11. Hansen PB, Jørgensen LM. Pancytopenia — a rare manifestation of folic acid deficiency. J Intern Med 1989;225:143–4.

    Article  CAS  PubMed  Google Scholar 

  12. Henri-Bhargava A, Melmed C, Glikstein R, et al. Neurologic impairment due to vitamin E and copper deficiencies in celiac disease. Neurology 2008;71:860–1.

    Article  PubMed  Google Scholar 

  13. Salmi TT, Collin P, Reunala T, et al. Diagnostic methods beyond conventional histology in coeliac disease diagnosis. Dig Liver Dis 2010;42:28–32.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik III, Universitätsklinikum Aachen (RWTH), Aachen, Germany

    Maximilian Hatting, Martin Meyer, Christian Trautwein &  Jens J. W. Tischendorf

  2. Medizinische Klinik IV, Universitätsklinikum Aachen (RWTH), Aachen, Germany

    Oliver Galm

  3. Medizinische Klinik III, Universitätsklinikum Aachen (RWTH), Pauwelsstraße 30, 52074, Aachen, Germany

    Jens J. W. Tischendorf

Authors
  1. Maximilian Hatting
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  2. Oliver Galm
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  3. Martin Meyer
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  4. Christian Trautwein
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  5. Jens J. W. Tischendorf
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Corresponding author

Correspondence to Jens J. W. Tischendorf.

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Hatting, M., Galm, O., Meyer, M. et al. Anämie und schwere Thrombozytopenie bei Sprue. Med Klin 105, 249–252 (2010). https://doi.org/10.1007/s00063-010-1035-5

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  • DOI: https://doi.org/10.1007/s00063-010-1035-5

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