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Haemoglobin decline before coeliac disease diagnosis: a nationwide transfusion cohort study of 1.1 million blood donors
  1. Jonas F Ludvigsson1,2,3,4,
  2. Arvid Sjölander1,
  3. Joseph A Murray5,
  4. Henrik Hjalgrim6,7,
  5. Gustaf Edgren1,8
  1. 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
  3. 3Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK
  4. 4Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
  5. 5Division of Gastroenterology and Hepatology, Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
  6. 6Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
  7. 7Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  8. 8Hematology Center, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Dr Jonas F Ludvigsson, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm SE-171 77, Sweden; jonasludvigsson{at}

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The recent British Society of Gastroenterology guidelines for the management and diagnosis of coeliac disease (CD) suggests that individuals with iron-deficiency anaemia be tested for CD.1 We have previously shown that decreasing haemoglobin (Hb) levels precede diagnosis of a number of malignancies, including most GI and haematological malignancies.2 If Hb levels begin to decline prior to CD diagnosis, this may provide a means to estimate the duration from disease onset to diagnosis.

We therefore set up a case-control study to examine Hb concentration before CD diagnosis using a similar approach as in a previous study.2 We first linked data on Hb concentration measured repeatedly for 1.1 million blood donors in the Swedish portion of the Scandinavian Donations and Transfusions database 2,3 with a nationwide histopathology database providing diagnosis of villous atrophy (ie, CD).4 We then identified 1567 donors diagnosed with incident CD during follow-up. For each of these case donors, we selected 10 control donors (n=15 665) matched for sex, age (±5 years) and date of first blood donation (±2 years) (see table 1 for details). We …

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