The evaluation of anemia parameters in patients with celiac disease and relationship with serum hepcidin levels


Thesis Type: Expertise In Medicine

Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey

Approval Date: 2013

Student: ÇAĞLAR KESKİN

Supervisor: MEHMET CİNDORUK

Abstract:

Celiac disease is an autoimmune disorder characterized by intolerance to dietary gluten. Anemia is the most common hematologic abnormality of celiac disease, with a prevalence ranging from 12% to 69% at diagnosis. In celiac disease duodenal mucosa, the site of maximal iron absorption, is damaged and consequently iron deficiency often develops. Hepcidine is a peptide molecule that is synthesized and secreted by the liver. Hepcidin is primary regulator of iron metabolism and a mediator of chronic disease anemia and chronic inflammation. Celiac disease is also characterized by inflammation and iron deficiency anemia. There are limited data showing behavior of hepsidin in celiac disease. In this cross sectional study, we investigated relationship between hepcidin levels and anemia parameters in celiac patients. 39 patients with newly diagnosed celiac, 16 patients with gluten free diet and not show signs of active disease and 30 healthy controls were included in the study. There was no significant difference between the groups according to age, sex distribution. In newly diagnosed celiac group, anemia was found in 18 patients at diagnosis.(%46) The most common forms of presentation were chronic diarrhea (%29,1), abdominal pain and dyspepsia (%29,1), weakness (%21,8) and weight loss (%14,5). Mean hemoglobin values were significantly lower in newly diagnosed celiac patiens (12.5±1.9) compared to patients on gluten-free diyet (14.3±1.2) and healthy controls (14.0±1.2) (p=0.03). Serum ferritin levels and transferin saturation index values were significantly lower in newly diagnosed celiac patients compared to other groups (p=0.002 and p=0.001). Mean hepcidin level was greater in celiac disease groups than controls but the difference was not statistically significant (p:0.172). In active celiac disease group, mean hepcidin level in patients with iron deficiency anemia was 20270±19048 pg/ml and 11617±11719 pg/ml in non-anemic patients. This difference was statistically significant (p:0.02). In correlation analysis, ferritin was the best correlated parameter with hepcidin (r=0.752, p<0.001). Other parameters positively correlated with hepsidin were serum iron and transferrin saturation. In our study, we did not detect any correlation between hepcidin level and inflammatory markers such as CRP, sedimantation and erythropoietin levels. Hepcidin, as a acute phase reactant, shows positive correlation with parameters of iron deficiency anemia in celiac disease that is characterized by weak systemic inflammation. In conclusion, hepcidin acts like a iron deficiency anemia parameter rather than inflammatory marker in celiac disease.