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Primary autoimmune haemolytic anaemia and coeliac disease

The clinical spectrum of coeliac disease (CD) is widely variable, from the classic malabsorption syndrome to the atypical and the silent forms (1). Epidemiological studies using highly sensitive and specific serological markers for CD, i.e. the anti-transglutaminase (tTG) and antiendomysium (AEA) antibody tests, found CD to be highly common in Europe (0.33%) (2). Because CD is often asymptomatic, the detection rate can be strongly increased by serology (2). Autoimmune disorders (including insulin-dependent diabetes, thyroid disease, autoimmune liver disease, cardiomyopathy) are ten times more common in patients with CD than in the general population. When both autoimmune disease and CD occur in a patient, CD is often silent, the autoimmune disorder being usually diagnosed first (1). The mortality risks are significantly elevated in CD patients for a wide array of diseases, including non-Hodgkin lymphoma, cancer of the small intestine and autoimmune diseases (3). Miller described two patients with autoimmune haemolytic anaemia (AIHA) strongly associated with CD. He hypothesized that AIHA may represent an extension of immunological disorders linked to CD, centred on the histocompatibility antigen B8 (4). AIHA is characterized by the production of antibodies directed against self-RBCs (5). On the basis of aetiology AIHA is classified as primary and secondary (to lymphoproliferative disorders, autoimmune disorders, infections, immunodeficiency disorders and tumours) (5). To the best of our knowledge, no data on patient series investigating an association between CD and primary AIHA are available in the literature at the moment. The aim of our study was to assess the prevalence of CD in patients with primary AIHA and in a population of healthy controls.