Extreme thrombocytosis as a sign of coeliac disease in theelderly: case report

Giuseppe Montalto, Lydia Giannitrapani, Antonio Carroccio, Antonio Carroccio, Emilio Iannitto, Lydia Giannitrapani, Lidia Di Prima, Alberto Notarbartolo, Giuseppe Montalto, Alberto Notarbartolo

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18 Citazioni (Scopus)

Abstract

Increase in the number of blood platelets to over1 000 000/mm3 in elderly patients is generally consideredsecondary to a myeloproliferative or neoplastic disease. Toreport the case of an elderly woman hospitalized forextreme thrombocytosis associated with severe anaemia,who was found to be suffering from coeliac disease. Thepatient, aged 83 years, was hospitalized presenting withfatigue. Laboratory tests showed microcytic hypochromicanaemia (haemoglobin 4 g/dl) and extremethrombocytosis (platelet count 1 400 000/mm3). Physicalexamination was normal, with the exception of markedthinness. There was no evidence of macroscopic bleedingfrom the gastrointestinal or genitourinary tracts. She hadnever suffered from gastrointestinal problems and had nofamily history of gastroenterological diseases.Oesophagogastroduodenoscopy and histology of thegastric and duodenal mucosa evidenced atrophic gastritisand an adenomatous polyp. The duodenal mucosa showedtotal villous atrophy, suggesting the diagnosis of coeliacdisease. Antiendomysial IgA and anti-transglutaminase IgAantibodies were also positive. Colonoscopy was negative.An ultrasound examination of the abdomen was normal,and the spleen was within the normal range. A peripheralblood smear showed no alterations in erythrocytemorphology typical of hyposplenism due to coeliacdisease. The platelet count decreased rapidly after bloodtransfusions, when both serum iron and ferritin levels werestill below normal limits. Furthermore, we observed asignificant inverse correlation between the platelet countand haemoglobin concentration (r 20.94, P < 0.003).Platelet count and red blood cell count normalized after2 months of a gluten-free diet; the haemoglobinconcentration was also normal at this time. After 1 year offollowing a gluten-free diet, the patient remained well andhad no complaints. There were no gastrointestinaldisturbances. All haematological parameters were withinnormal limits. Intestinal biopsies showed normal villi andcrypts without inflammatory infiltration of the laminapropria. This case shows that the association ofhaematological signs – extreme thrombocytosis andsevere anaemia – considered in an elderly patient to betypical of myeloproliferative disorders or neoplasticconditions can be due to coeliac disease; thus, coeliacdisease must also be considered among the possiblediagnoses.
Lingua originaleEnglish
Numero di pagine4
RivistaEUROPEAN JOURNAL OF GASTROENTEROLOGY &amp; HEPATOLOGY
Stato di pubblicazionePublished - 2002

All Science Journal Classification (ASJC) codes

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