Idiopathic Thrombocytopenic Purpura and Celiac Disease by Ron Hoggan I have only found three reports in the literature suggesting a coincidence of the two above-mentioned conditions (1, 2, 3). And yet, I was recently contacted by Karen Brinser, whose mother had been diagnosed with celiac disease and had a section of her bowel was surgically removed due to a small bowel adenocarcinoma. Karen indicated she had ITP, and asked if there could be any connection with celiac disease. I responded with the three citations to journal articles, along with some comments from Cooke & Holmes indicating that the platelet count could rise in celiac disease (4) (page 122). I seem to have missed the comment, later on the same page, that the platelet count can also be considerably diminished in the presence of granulopenia. They go on to say that granulopenia is not uncommon in celiac disease, and approximately 10% of celiac patients have total white cell counts less than 3500 per cmm and approximately the same percentage have either a neutropenia of less than 3000 or a lymphopenia of less than 1500 per cmm. Karen took the initiative and posted to the celiac listserv asking for responses from those who have experience with both celiac disease and ITP. One parent wrote about a daughter who had previously experienced ITP, but had regained her health since the diagnosis and treatment of her celiac disease. A middle-aged man who had suffered from ITP during the 1960's and 1970's and was treated with corticosteroids, was diagnosed with celiac disease in 1980. His ITP also seems to have resolved. A woman was diagnosed with both celiac disease and ITP at the same time, three years ago. Her gastroenterologist thought the two were related as both are auto immune diseases. Another woman had two severe bouts with reduced platelet levels occurring at ages 38 and again at age 45. At age 59 she was diagnosed with celiac disease and now blames the celiac disease for a variety of health problems, including her bouts with abnormal platelet levels. Another woman's ITP eventually led her astute (my opinion) doctor, after excluding leukemia, in the direction that led to the diagnosis of her celiac disease. A father discussed his own and his daughter's symptoms of purpura, as well as some associations between celiac disease and damage to capillaries. He structured some very thoughtful, compelling arguments suggesting that abnormal WBCs and platelet counts may well be associated with celiac disease. He also indicated that his symptoms had abated on the gluten-free diet. Another parent had one daughter diagnosed with celiac disease. When their other daughter started to develop symptoms of cd they put her on a g-f diet. At age five, they re-introduced wheat to her diet to see if she could tolerate it. She was subsequently hospitalized due to ITP. At the time, the parents thought the ITP might have been due to a drug reaction. The daughter was returned to the gluten-free diet due to other celiac-like symptoms, and has not had any significant health problems since. All these anecdotal reports, but in combination with Cook & Holmes' comments, and the three journal articles, the possibility of a connection seems reasonable. It is at least a connection worthy of investigation, as ITP can be deadly, as can some of the sequelae of celiac disease. Given the delays between presentation of ITP, and diagnosis of celiac disease, the former may be a valuable indicator of the possibility of the latter. If you have questions for Karen Brinser, she can be reached at: firstname.lastname@example.org SOURCES: 1. Kahn O, Fiel MI, Janowitz HD Celiac sprue, idiopathic thrombocytopenic purpura, and hepatic granulomatous disease. An autoimmune linkage? Clin Gastroenterol 1996 Oct;23(3):214-216 2. Sheehan NJ, Stanton-King K Polyautoimmunity in a young woman. Br J Rheumatol 1993 Mar;32(3):254-256 3.Stenhammar L, Ljunggren CG Thrombocytopenic purpura and coeliac disease. _Acta Paediatr Scand_ 1988 Sep;77(5):764-766 4. Cooke W & Holmes G (1984) _Coeliac Disease_ Churchill Livingstone, NY 5. Nelson E, Ertan A, Brooks F, Cerda J, (1976). Thrombocytosis in patients with coeliac sprue. _Gastroenterology_ 70, 1042-1044 6. Croese J, Harris O, Bain B,(1976). Coeliac Disease. Haematological features and delay in diagnosis. _Medical Journal of Australia_ 6, 335-338 7. Bullen A, Hall R, Brown R, Losowsky M, (1977). Mechanisms of Thrombocytosis in coeliac disease. _Gut_ 18, 962.