ABSTRACT
Gluten sensitive enteropathy [celiac disease [CD]] has a strong association with diabetes mellitus [type 1DM]. Since, 2-3% of CD patients have selective IgA deficiency, the majority of the available tests may fail to show the auto-antibodies [the IgA endomysial antibody [EMA]. To prevent such a false negativity, a new Enzyme Linked Immune Sorbent Assay [ELISA] test has been introduced to detect both IgG and IgA antibodies reactive with tissue transglutaminase [tTG], an autoantigen in CD patients. This study has been conducted to detect celiac disease among Sudanese patients with type 1 autoimmune diabetes using anti-tissue transglutinamase antibodies as a diagnostic tool. Samples were collected from sixty nine randomly selected patients [38 males and 31 females] and their age ranged between 3-22 years with DM type 1 who were attending the outpatient clinics in Gabir Abu Eliz diabetic Center and Omdurman Pediatric Emergency Hospital. Blood samples were collected from 25 healthy individuals as controls. Levels of tTG specific IgA, tTG specific IgG and anti-endomysial antibodies of IgA class were measured in sera collected from both cases and from controls. All the results were analyzed using Statistical Packages of Social Sciences [SPSS] version 17 and MicroSoft office excel. Seven out of 69 patients with DM type 1 [10.1%] were identified as having CD using IgG anti-tTG and 5 [7.2%] of them were positive for IgA anti-tTG and IgA anti-endomysial antibodies. The mean of both anti-tTG IgA and IgG titers were higher in diabetic patients [M +/- SD = 12.30 +/- 41.0 and 7.2 +/- 13.1 respectively] when compared with the control group [M +/- SD =1.8 +/- 1.1 and 1.8 +/- 0.9 respectively], however, only anti-tTG IgG antibodies titer achieved statistical significance. The present study revealed that patients with DM type I have an increased tendency to develop CD. The increased association of CD and selective IgA deficiency is a potential source of false-negative IgA, therefore testing for IgG class autoantibodies is recommended if celiac disease is suspected. Antibodies to tTG antigen fall once a gluten-free diet has begun, thus facilitating monitoring of dietary compliance. Thus, anti-tTG antibodies are highly sensitive marker for celiac disease with 95- 100% sensitivty, and specificity of 90 to 97%
ABSTRACT
Blood transfusion is an integral part in the management of sickle cell disease patients. Allogeneic blood transfusion is a form of temporary transplantation. A recipient often mounts an immune response to the donor antigens resulting in various clinical consequences including delayed hemolytic transfusion reactions. Delayed reaction is often seen in individuals who have received repeated transfusion of ABO compatible blood that incompatible for other blood group antigens because of minor allelic difference stimulate the production of IgG antibodies. In the patients who have sickle cell disease the majority of tests may have low sensitivity and in turn may fail to show the autoantibodies. This study has been conducted for detection of allo-antibodies in patient with sickle cell anaemia and hemophilia who received repeated blood transfusions using newly introduced test system; the DiaMed-Immuno-Diffusion microtyping system. Samples were collected randomly from 60 patients with repeated blood transfusions. Micro column gel test as well as agglutination method were performed for all samples. All the results were analyzed using Statistical Packages of Social Sciences [SPSS]. This test provides clear and stable reactions that improve result interpretation. It proved to be more sensitive than the conventional tube agglutination technique as it captures agglutinate in a semi solid medium and on the other hand it has the capacity to detect unexpected antibodies. This in turn enhances visibility of agglutination compared to the traditional Tube techniques