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Bleeding Complications (Bruising or Hematoma) as First Sign of Celiac Disease


Editors’ note: This case report illustrates that a person can live a long time reporting apparent good health and be completely unaware that they have symptoms of celiac disease. In this case, hematomas, (which are swollen black and blue marks caused by a break in the wall of a blood vessel), that developed on his legs caused the patient to seek medical attention. The ability of his blood to clot was severely impaired and yet there was no other manifestation of hemorrhage.

“Endemic Sprue: Its First Diagnosis Based on Bleeding

Complications.”

Heidinger K, Kemkes-Mathes B, Mathes KJ, Franke F, Voss R, Heckers H

Deutsche medizinische Wochenschrift. 1995 nov 10 Vol. 120 (45), 1543-6

Background: A 47-year old man without previously known illness was admitted to hospital because of acute hematomas in the legs: the history revealed no cause. The pale looking patient reported having large and foul-smelling stools once or twice daily. There were large hematomas and swellings on both legs. His general and nutritional state was reduced. “Bleeding of unknown origin” was suspected at the time.

Investigations: Hemoglobin concentration was 5.6 g/dl, while iron was normal and ferritin reduced.  Quick value was below 5%, activated partial thromboplastin time prolonged to 180s. Vitamin A and E concentrations were reduced; coumarin derivatives were not demonstrated in blood.  Abdominal ultrasonography showed clearly thickened intestinal walls.

Treatment: Four units of erythrocyte concentration were immediately administered, together with 2000 IU factors II, VII, X and anti-hemophilic factor B, and 10 mg vitamin K intravenously. As intestinal malabsorption was suspected, a vitamin A absorption test was performed: it indicated malabsorption. Upper intestinal endoscopy showed celiac disease, as did a biopsy. The patient’s condition quickly improved after he had been given vitamins D, E and K and put on a gluten-free diet.

Conclusions: Celiac disease can take a clinically unremarkable course for a long time and may finally become manifest through an isolated abnormality, such as bleeding.

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Author Information: Cleo Libonati, RN, BSN
Cleo Libonati is a Co-Founder of Gluten Free Works, Inc. She is the author of Recognizing Celiac Disease.
She can be reached by E-mail.

About Cleo Libonati, RN, BSN

Cleo Libonati, RN, BSN
Cleo Libonati, RN, BSN is CEO and co-Founder of Gluten Free Works, Inc. and Glutenfreeworks.com. She is the author and publisher of the highly recommended celiac disease reference guide, Recognizing Celiac Disease.

4 comments

  1. Becky, ulcerative colitis involves bleeding of the intestinal wall. UC is a symptom of celiac, correct me if I am wrong Cleo Libonati. So I do believe UC could cause bleeding elsewhere. I hate to say it, but the bleeding in UC is a blessing of sorts…it is a visible sign you are doing something wrong, and not a hidden inflammation….fix the diet, and the bleeding stops and the UC heals. A side note on dairy… fresh, raw dairy rarely causes problems. It is the pasteurized dairy, which is zapped of all probiotics, enzymes, etc…and the lactase enzyme, which helps you digest dairy. Raw dairy has the lactase enzyme, and helps you digest the dairy.

  2. I am a Celiac patient, diagnosed in November 2010, and on a strict gf diet. Since being diagnosed, tho, when traveling I get tons of bruises, mainly on my legs, and I start looking like a dalmation. My dr did bloodwork the last time it happened, but everything came back normal. Does anyone know why traveling would cause bruising even tho I’m sticking to my gf diet?

    • Hi Ann,

      Better late than never – Coeliacs have a range of vitamin deficiencies. Since vitamins A, D, E & K are fat soluble, the malabsorption of fat can lead to deficiencies in these vitamins. Vitamin K is intrinsically involved in the clotting process so its deficiency can result in easy bruising and prolonged bleeding from minor wounds.

  3. I’m curious what other research/findings/cases there are about bleeding, particularly internal, with gluten or dairy intolerance – or celiac. When I eat certain foods, as well as certain amounts of these foods, I have what I call “internal bleeding” – same thing happens when I eat pork, dairy, etc.

    Anyone heard of this? I’d say it’s intestinal, but the Drs chalk it up to IBS or “other”. Lots to learn! Haven’t had it in a while, things that make me go hmmmm. Thanks for sharing this.

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