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:
brinser@lancnews.infi.net

                              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.