CLINICAL PICTURE OF SEVERE ANEMIA IN CHILDREN WITH CELIAC

Celiac disease is an immune-mediated systemic disease that occurs in response to the consumption of gluten or related prolamins by genetically predisposed individuals and is characterized by a wide combination of gluten-dependent clinical manifestations. The average worldwide detection rate of antibodies specific for celiac disease is 1.4%, while 0.7% of the world’s population has histologically confirmed disease. The prevalence of the disease is much higher in children than in adults.

The article describes cases of severe iron deficiency and B12 deficiency anemia in two children: a 3-yearold girl and a 14-year-old boy. The children significantly lagged behind in physical development, both had a pronounced underweight (weight SDS below -2.5). The girl was short (height SDS -3.39), with thin limbs and a large belly. An examination revealed severe microcytic hypochromic anemia (hemoglobin 66 g/l, MCV 57.0 fl, MCH 15.1 pg, MCHC 26.5 g/dl, RDW-CV 23.4%), decreased levels of serum iron and ferritin. The boy had severe macrocytic hyperchromic anemia (hemoglobin 44 g/l, MCV 110.6 fl, MCH 38.9 pg, MCHC 35 g/dl, RDW-CV 18.1%), low serum vitamin B12 activity. To determine the cause of anemia, both children underwent esophagogastroduodenoscopy with biopsy from the postbulbar part of duodenum. The morphological picture corresponded to celiac disease, Marsh II. The girl was found to have elevated titers of antibodies to endomysium Ig A, Ig G, to diamidated gliadin peptides of the class Ig G, Ig A. The cause of severe anemia in the children was malabsorption syndrome caused by celiac disease. This diagnosis was made for the first time. The children were consulted by a gastroenterologist and a strict gluten-free diet was recommended. When questioning the girl’s mother and the boy’s guardian by phone 4 and 3 months, respectively, from the date of discharge from the hospital, it turned out that the children did not follow the prescribed diet. This can be explained by late diagnosis, lack of awareness of parents (guardians) about celiac disease and its consequences.

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