Laboratory Diagnosis of Celiac Disease in Patients with Selective IgA Deficiency.

Abstract

A 49-year-old woman presented to the emergency department complaining of nausea, vomiting, and epigastric pain for 3 days. The initial workup was consistent with acute pancreatitis (with increased serum amylase and lipase), for which she was treated with fluids, morphine, and supportive care. Past medical history was marked by gastroesophageal reflux disease and hypertension. She also admitted to heavy alcohol consumption. Her hemoglobin on admission was 8.7 g/dL (reference, 11.5–15.5 g/dL), which dropped to 6.3 g/dL during her stay, and she was transfused with 2 units of packed red blood cells. Review of the peripheral blood smear revealed mild hypochromia and microcytosis, but was otherwise unremarkable. The mean corpuscular volume was 73 fl (reference, 80–96 fl). The ferritin concentration was 5 ng/mL (reference, 10–150 ng/mL). The patient had been seen 2 years earlier for a routine visit, at which time her hemoglobin was 11.0 g/dL. An upper gastrointestinal endoscopy was performed 2 weeks after her discharge from the emergency department to rule out a potential source of bleeding. It revealed diffuse erythema and granularity in the stomach and a reduction of duodenal folds. Biopsies of the stomach revealed chronic inflammation consistent with inactive gastritis. Staining for Helicobacter pylori was negative. Biopsies of the duodenum revealed patchy areas of villus blunting with crypt …