A 3.5-year-old girl with severe anemia caused by copper deficiency was found to have celiac disease, an immune condition triggered by gluten. According to Gram Research analysis, this case report shows that celiac disease can present with unusual nutritional deficiencies beyond the typical iron deficiency anemia. Her hemoglobin dropped to a dangerous 1.6 g/dL, requiring blood transfusions, but improved after starting a gluten-free diet and copper supplements. This rare presentation reminds doctors to consider celiac disease when children have unexplained severe anemia with micronutrient deficiencies.
A 3.5-year-old girl presented with severe anemia so profound she needed blood transfusions, but doctors couldn’t find the typical causes. After extensive testing, researchers discovered she had celiac disease, an immune condition triggered by eating gluten. What made this case unusual was that her anemia came from copper deficiency rather than the more common iron deficiency. Once she started a gluten-free diet and received copper supplements, her blood counts returned to normal. This case report reminds doctors that celiac disease can hide behind unexpected nutritional problems, not just the symptoms people typically expect.
Key Statistics
A case report published in JPGN Reports in 2026 documented a 3.5-year-old girl with celiac disease whose severe anemia was caused by copper deficiency rather than the more common iron deficiency, with hemoglobin levels as low as 1.6 g/dL requiring blood transfusions.
The child’s hemoglobin and copper levels normalized after treatment with a strict gluten-free diet and copper supplementation, demonstrating that addressing the underlying celiac disease resolved the atypical micronutrient deficiency.
Markedly elevated celiac disease antibodies combined with low serum copper levels and intestinal damage on endoscopy confirmed that this 3.5-year-old’s severe anemia was a rare pediatric presentation of celiac disease.
The Quick Take
- What they studied: Why a young child developed severe anemia that didn’t respond to normal treatments and what caused it
- Who participated: One 3.5-year-old girl who came to the hospital with severe anemia, mild stomach symptoms, and weight loss
- Key finding: The child had celiac disease caused by gluten sensitivity, but her severe anemia came from copper deficiency rather than iron deficiency, which is the more common cause
- What it means for you: If a child has severe anemia that doctors can’t easily explain, celiac disease should be considered as a possible cause, even if the typical signs aren’t present. This is especially important because treating the underlying celiac disease with a gluten-free diet can fix the problem.
The Research Details
This is a case report, which means doctors documented the medical story of one patient in detail. The 3.5-year-old girl arrived at the hospital with very low hemoglobin (a protein in red blood cells that carries oxygen), measuring just 1.6 grams per deciliter, which is dangerously low. She needed blood transfusions to survive. The medical team ran many tests to figure out what was causing her anemia, including checks for infections, inflammation, blood disorders, and cancer. All of these came back negative or didn’t explain her condition. The doctors then tested for celiac disease by checking blood markers and performing an endoscopy, which is a procedure where a small camera looks inside the digestive tract. They also measured her copper levels and found them to be very low.
Case reports are important because they describe unusual or rare presentations of diseases that doctors might not expect. By documenting this case, the medical team alerts other doctors that celiac disease can sometimes show up as copper deficiency anemia rather than the typical iron deficiency anemia. This helps other physicians think more broadly when they encounter similar puzzling cases.
As a case report of a single patient, this study cannot prove that copper deficiency anemia is common in celiac disease. However, it provides valuable clinical insight and serves as a warning sign for doctors to consider celiac disease in unexplained severe anemia cases. The diagnosis was confirmed through multiple methods: blood tests for celiac antibodies, endoscopy with tissue samples, and measurement of copper levels, which strengthens the reliability of this single case.
What the Results Show
The child presented with severe anemia (hemoglobin of 1.6 g/dL) that required blood transfusions. She also had mild abdominal symptoms and had lost weight. Initial investigations for common causes of anemia, including infections and blood disorders, were all negative. Blood tests showed markedly elevated celiac disease antibodies, indicating an immune response to gluten. Her serum copper level was significantly low. An endoscopy revealed damage to the small intestine consistent with celiac disease (Marsh 3B changes). After starting a strict gluten-free diet and copper supplementation, her hemoglobin levels normalized, her copper levels returned to normal, and her growth parameters improved.
The case demonstrates that celiac disease can present with atypical micronutrient deficiencies beyond the commonly recognized iron deficiency. The child’s weight loss and mild abdominal symptoms, combined with severe anemia, initially masked the underlying nutritional absorption problem caused by intestinal damage from gluten exposure.
While iron deficiency anemia is the well-known presentation of celiac disease in children, this case adds to a small body of literature showing that other micronutrient deficiencies can occur. Copper deficiency as the primary presentation of celiac disease is rare in pediatric cases, making this report valuable for expanding clinical awareness.
This is a single case report, so the findings apply only to this one child and cannot be generalized to all children with celiac disease. The report does not establish how common copper deficiency anemia is in celiac disease or whether this presentation occurs in other age groups. Doctors cannot use this case alone to change how they screen for celiac disease, but it should raise suspicion in similar puzzling cases.
The Bottom Line
Doctors should consider testing for celiac disease in children with severe, unexplained anemia, especially when standard causes are ruled out and micronutrient deficiencies are present. A gluten-free diet is the primary treatment for celiac disease, with targeted supplementation for specific deficiencies like copper. Confidence level: Moderate, based on this single well-documented case and existing knowledge about celiac disease complications.
Pediatricians and hematologists should be aware of this atypical presentation. Parents of children with unexplained severe anemia should discuss celiac disease testing with their doctors. This is particularly relevant for children who have not responded to standard anemia treatments.
In this case, after starting the gluten-free diet and copper supplementation, the child’s hemoglobin levels normalized over time, though the exact timeline to full recovery was not specified in the report. Most children show improvement in anemia within weeks to months of starting a gluten-free diet.
Frequently Asked Questions
Can celiac disease cause anemia other than iron deficiency?
Yes. While iron deficiency anemia is most common, celiac disease can cause deficiencies in other nutrients like copper, leading to different types of anemia. This case report describes a child whose severe anemia came from copper deficiency caused by celiac disease.
What are the signs that a child might have celiac disease?
Common signs include abdominal pain, bloating, diarrhea, weight loss, and fatigue. This case shows that severe anemia with unexplained low blood counts can also be a sign, especially when other causes have been ruled out.
How is celiac disease diagnosed in children?
Doctors use blood tests to check for celiac antibodies and perform an endoscopy to examine the small intestine for damage. In this case, both tests confirmed celiac disease, along with low copper levels.
What is the treatment for celiac disease?
The primary treatment is a strict gluten-free diet for life. In this case, the child also needed copper supplementation to correct the deficiency. Once treatment started, her anemia improved and her growth returned to normal.
How long does it take to recover from celiac disease anemia?
Recovery varies, but many children show improvement in anemia within weeks to months of starting a gluten-free diet. In this case, the child’s hemoglobin and copper levels normalized with treatment, though the exact timeline was not detailed.
Want to Apply This Research?
- Track hemoglobin levels and copper intake weekly if you have a child with celiac disease and anemia. Record symptoms like fatigue, shortness of breath, and weight changes to monitor improvement after dietary changes.
- If celiac disease is diagnosed, use the app to log all foods consumed to ensure strict gluten avoidance. Set reminders for copper supplementation if prescribed, and track energy levels and appetite changes as markers of improvement.
- Create a long-term tracking dashboard showing hemoglobin trends, copper levels from lab work, growth measurements, and symptom severity. Compare monthly to establish whether the gluten-free diet and supplementation are working effectively.
This case report describes one child’s experience and should not be used to diagnose or treat celiac disease or anemia in other individuals. If your child has severe anemia, unexplained weight loss, or abdominal symptoms, consult with a pediatrician or gastroenterologist for proper evaluation and testing. Celiac disease diagnosis requires blood tests and medical confirmation. Do not start a gluten-free diet without medical guidance, as this can interfere with accurate testing. This information is educational and not a substitute for professional medical advice.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.