Article Text

Download PDFPDF
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}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

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 …

View Full Text


  • Contributors JFL and GE conceived and designed the study with input from the other authors. JFL, GE and HH collected the data. JFL and GE jointly wrote the first draft of the paper, supervised the project and funded this study. GE and AS analysed the data. All authors interpreted the data and contributed to the writing of the paper. All authors revised and approved the final version.

  • Funding All authors have completed the International Committee of Medical Journal Editors uniform disclosure form at and declare (that) this project was supported by grants from the Swedish Society of Medicine and the Stockholm County Council. The assembly of the Scandinavian Donations and Transfusions database 2 was made possible through grants from the Swedish research council (2011-30405, 2007-7469), the Swedish Heart-Lung Foundation (20090710), the Swedish Society for Medical Research (Edgren), the strategic research programme in epidemiology at Karolinska Institutet and the Danish Council for Independent Research (2009B026).

  • Disclaimer This manuscript represents the views of the authors.

  • Competing interests None declared.

  • Ethics approval This project (2016/940-31/1) was approved by the Ethics Review Board in Stockholm, Sweden on 20 June 2016.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Other researchers can apply for our data through the Swedish National Board of Health and Welfare.

  • Transparency The lead author affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.