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- W2002739885 abstract "A 37-year-old woman was referred for evaluation of mild anaemia and thrombocytosis. History revealed the onset of vitiligo at the age of 18 years, premature delivery of a first pregnancy at the age of 33 years and diagnosis of autoimmune hypothyroidism 3 months before referral. When seen in our clinic she was feeling well. Except for vitiligo, the physical examination was unremarkable. Haemoglobin was 11·3 g/dl with normal red cell indices, the platelet count was 727 × 109/l and the leucocyte count was 10 × 109/l with a normal distribution. Blood films showed spur cells, target cells and numerous Howell Jolly bodies (top left), indicating functional hyposplenism. Computerized tomography revealed a small, calcified spleen measuring 6 × 2 × 1·5 cm (top right). Confronted with the results, the patient remembered that as a child she had been on a restricted diet and had been given only home-made bread prepared especially for her. Tests for presumptive coeliac disease were positive for IgG anti-gliadin antibodies, but IgA anti-gliadin and anti-endomysial antibodies were negative owing to severe IgA deficiency (IgA < 0·5 g/l). Complete villous atrophy with crypt hyperplasia on intestinal biopsy (bottom) confirmed the diagnosis of coeliac disease. Howell Jolly bodies are found after splenectomy or with pronounced functional hyposplenia. Subtle changes in the blood film indicating functional hyposplenism are frequent in coeliac disease patients. Complete splenic atrophy is rare." @default.
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- W2002739885 date "2001-08-01" @default.
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- W2002739885 title "Howell Jolly bodies and a history of home-made bread" @default.
- W2002739885 doi "https://doi.org/10.1046/j.1365-2141.2001.02929.x" @default.
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