Presence of anemia in patients with celiac disease suggests more severe disease.

Most of celiac disease (CeD) patients have anemia, and its diagnosis is seldom considered in the presence of normal hemoglobin. However, over the past few years, we have observed a few CeD patients having normal hemoglobin. Therefore, we reviewed our CeD database to find out what proportion of CeD patients had normal hemoglobin levels and if there were any differences in characteristics of those with and without anemia. Of 338 CeD patients, 14.8 % had normal hemoglobin levels at diagnosis. When compared with CeD patients without anemia, those with anemia had significantly longer duration of symptoms, lower albumin levels, and higher anti-tissue transglutaminase fold rise, and a higher proportion had abnormal d-xylose tests and severe villous abnormalities. Thus, CeD patients with anemia had more severe disease than those without anemia. It is therefore important to diagnose these patients at an earlier stage of the disease even when the classical feature such as anemia is not clinically evident.