The Diagnostic Utility of Flow Cytometry in Celiac Disease Presented Isolated Iron Deficiency Anemia
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Rafet Mete1, Mustafa Oran2, Burcu Altındağ Avcı2
1Department of Gastroenterology, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey.
Insights
Flow cytometry of intestinal lymphocytes aids celiac disease diagnosis. Increased CD3+/TCRγδ+ intraepithelial lymphocytes can identify atypical celiac disease presenting as iron deficiency anemia.
Area of Science:
- Gastroenterology
- Immunology
- Diagnostic Medicine
Background:
- Flow cytometric analysis of intestinal intraepithelial lymphocytes (IELs) is crucial for celiac disease diagnosis.
- Atypical celiac disease can manifest solely as iron deficiency anemia.
- This study explores the diagnostic value of IEL flow cytometry in atypical celiac disease.
Purpose of the Study:
- To evaluate the utility of flow cytometric analysis of IELs in diagnosing celiac disease, particularly in patients with unexplained iron deficiency anemia.
- To determine specific IEL subsets that can serve as diagnostic markers for celiac disease.
Main Methods:
- Three patient groups were established: unexplained iron deficiency (n=22), confirmed celiac disease (n=14), and controls (n=56).
- Duodenal biopsy samples underwent flow cytometric analysis to quantify T cell receptor gamma-delta (TCRγδ) IELs and CD3-/CD103+ IELs.
- Sensitivity and specificity of flow cytometric variables were calculated for diagnostic assessment.
Main Results:
- CD3+/TCRγδ+ IELs were significantly elevated in celiac disease patients compared to other groups.
- Receiver operating characteristic (ROC) curve analysis identified a cut-off of 16.39% for CD3+/TCRγδ+ IELs.
- This cut-off demonstrated 91.7% sensitivity and 80.4% specificity in diagnosing celiac disease among patients with iron deficiency anemia.
Conclusions:
- Elevated intestinal CD3+/TCRγδ+ IELs show promise as a diagnostic marker for celiac disease.
- This flow cytometric method can aid in identifying atypical celiac disease presentations, such as iron deficiency anemia.
- Flow cytometry offers a valuable tool to complement serologic and histologic diagnostic methods for celiac disease.
Background:
Flow cytometric analysis of intestinal intraepithelial lymphocytes contributes to the diagnosis of celiac disease. Celiac disease may present with iron deficiency anemia alone which is considered as one of the forms of atypical celiac disease. In this study, we have aimed to investigate the diagnostic utility of flow cytometric analysis of intraepithelial lymphocytes in this atypical form.
Methods:
Three groups were formed: the patients with unexplained iron deficiency (group 1), the patients with celiac disease (group 2), and the patients who underwent gastroduodenoscopy for other reasons (group 0). Duodenal biopsy samples were used for flow cytometric analysis of intraepithelial lymphocytes. T cell receptor gammadelta intraepithelial lymphocytes and CD3-/CD103+ intraepithelial lymphocytes were determined with relevant monoclonal antibodies. Sensitivity-specificity calculation was performed to evaluate the usability of flow cytometric variables as diagnostic tests.
Results:
Group 1 had 22 patients, group 2 had 14 patients, and group 0 had 56 patients. In the comparison of the 3 groups, CD3+/ TCRγδ+ intraepithelial lymphocytes were found to be higher in celiac patients than other cases. CD3+/TCRγδ+ intraepithelial lymphocyte was evaluated for its usability as a diagnostic test. The cut-off value of CD3+/TCRγδ+ intraepithelial lymphocyte as 16.39% according to receiver operating characteristics curve analysis determined celiac disease in 14 of 22 patients in group 1 with 91.7% sensitivity and 80.4% specificity.
Conclusions:
Although celiac disease is diagnosed with serologic tests and histologic examination, successively, the increase in intestinal CD3+/TCRγδ+ intraepithelial lymphocytes may be used as a diagnostic test, and it may assist in revealing atypical forms of celiac disease.
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