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A 9-year-old child is referred by the general practitioner to the general paediatric clinic with a haemoglobin (Hb) of 10.2 g/dL, mean cell volume (MCV) 72 fL and ferritin 9.8 µg/L. The child is otherwise well and reports no history of bleeding or gastrointestinal (GI) symptoms and has a good balanced diet. You decide to treat with a course of oral iron therapy but wonder if you should investigate now for coeliac disease (CD).
Structured clinical question
Patient: Child presenting with iron deficiency anaemia (IDA)
Intervention: Screening for CD
Outcome: Diagnosis of CD
In children presenting with IDA, is screening for CD worthwhile in the absence of GI symptoms?
Embase, Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched (1946–May 2013) using the criteria ‘anaemia’, ‘iron deficiency’ and ‘coeliac disease’ limiting the results to ‘all child (0–18 years)’. These searches retrieved 58 individual articles, eight of which were considered relevant. The rest were excluded as irrelevant, adult studies or were single case reports or letters.
A further search of the above and tissue transglutaminase (tTG) antibody was carried out using Medline and Embase; this did not find any further relevant papers.⇓