Haemoglobin decline before coeliac disease diagnosis: a nationwide transfusion cohort study of 1.1 million blood donors

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...

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