How Often Do Hematologists Consider Celiac Disease in Iron-Deficiency Anemia?

As a hematologist, it is imperative to consider celiac disease as a potential underlying cause of iron deficiency anemia (IDA). Personal experience and professional peer discussions highlight that it should be a regular part of the diagnostic process, especially when no more obvious causes such as chronic blood loss can be identified.

Common Causes of Iron-Deficiency Anemia and Their Prevalence

Iron-deficiency anemia can be caused by various factors, including chronic blood loss, poor dietary intake, and malabsorption. While chronic blood loss from sources such as heavy menstrual cycles or gastrointestinal bleeding is a common and readily identifiable cause, some cases remain unresolved despite thorough investigations. In such instances, celiac disease should be considered as a potential cause.

Importance of Routine Screening for Celiac Disease

The rationale behind routine screening for celiac disease lies in its high incidence among patients with iron-deficiency anemia. According to a comprehensive 7-year review, celiac disease was identified in approximately 3.2% of individuals diagnosed with iron-deficiency anemia. This highlights the significance of incorporating celiac disease screening into the diagnostic algorithm for IDA.

Challenges in Identifying Celiac Disease

The prevalence of celiac disease in the general population is around 1%, and it often goes undiagnosed, partly due to the wide range of nonspecific symptoms such as fatigue, abdominal pain, and nutritional deficiencies. However, its association with iron-deficiency anemia provides a clear and actionable rationale for hematologists to include it in their diagnostic considerations.

Strategies for Implementing Celiac Disease Screening in Hematology Practice

To effectively integrate celiac disease screening into clinical practice, hematologists can adopt the following strategies:

Screening Blood Tests: Requesting screening blood tests for celiac disease is straightforward and should be incorporated into the routine diagnostic workup for iron-deficiency anemia. Baseline Data Collection: Collecting baseline data on dietary habits and symptoms can help flag individuals who may be at higher risk for celiac disease. Coverage of Genetic Testing: While serological markers are useful, genetic testing can provide a definitive diagnosis, especially in cases where initial screening results are inconclusive.

Conclusion

In conclusion, hematologists should prioritize the consideration of celiac disease when investigating cases of iron-deficiency anemia where no more obvious causes are evident. Routine celiac disease screening is not only justified by the high prevalence in this patient population but also by its noninvasive nature and the potential benefits of early diagnosis and treatment. By incorporating this essential diagnostic step, hematologists can ensure more thorough and effective management of iron-deficiency anemia and improve patient outcomes.