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Allergy & Intolerance

Anti-tTG in women: coeliac disease, fertility and anaemia

According to Thuisarts, in coeliac disease the immune system attacks healthy gut cells, and according to the NVKC it makes antibodies against tissue transglutaminase, a protein in the gut wall: anti-tTG. According to the NVKC, that protein is involved in breaking down and absorbing nutrients.

According to Thuisarts, long-lasting gut inflammation in coeliac disease can disturb the absorption of nutrients, with anaemia, for example, as a result. Only a blood test shows anti-tTG.

Unilabs uses a limit of below 7 kU/l for anti-tTG IgA.

Doctor's Assessment Included

Anti-tTG are antibodies against tissue transglutaminase, a protein in the gut wall, which the immune system makes in coeliac disease. According to the NVKC, when anti-tTG is detected the chance of coeliac disease is high, and a bowel biopsy can establish the diagnosis with certainty.

  • Star-SHL calls anti-tTG IgA below 7.0 U/ml negative and above 10.0 U/ml positive; Unilabs uses below 7 kU/l and Diagnostiek voor U below 8 U/mL.
  • According to Thuisarts, anti-tTG testing for coeliac disease requires carrying on eating gluten, because the doctor can only investigate coeliac disease while someone still eats gluten.
  • Anti-tTG is measured when coeliac disease is in question, which according to Thuisarts 1 in 100 people in the Netherlands have.

Anti-TTG (Tissue Transglutaminase): what Dutch laboratories use

There is no nationally agreed reference value; this is what individual laboratories publish.

The upper limit runs from 7 u/ml at Star-shl to 8 u/ml at Diagnostiek voor U.

Reference ranges by group, in u/ml
Star-shl · Everyone · a limit, not a range · IgA, negative < 7 U/ml
7
Star-shl · Everyone · IgA, doubtful 7–10 U/ml
7 10
Star-shl · Everyone · a limit, not a range · IgA, positive > 10 U/ml
10
Unilabs · Everyone · a limit, not a range · IgA < 7 kU/l
Diagnostiek voor U · Everyone · a limit, not a range · IgA < 8 U/mL
8
6.25 10.75 u/ml

Source: Star-shl

Source: Unilabs

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

Anti-TTG (Tissue Transglutaminase): what this test measures

According to the NVKC, an anti-tTG result shows whether antibodies against tissue transglutaminase of the IgA type are in the blood. Unilabs measures in kU/l with ELiA and gives a measurement uncertainty of 11.4%.

Anti-TTG (Tissue Transglutaminase): why this value matters

According to Thuisarts, coeliac disease, which the anti-tTG test looks for, is more common in women than in men, and according to Thuisarts reduced fertility can be one of its symptoms.

Anti-TTG (Tissue Transglutaminase): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test
Celiac Disease · €184,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Anti-TTG (Tissue Transglutaminase): how to prepare

  1. Keep eating gluten

    Required

    Eat gluten every day, in more than one meal, for at least 6 weeks before the draw. If you already eat gluten-free, the test can come back falsely negative.

  • Water is always fine. Drink as usual beforehand, it makes the draw easier.
  • Take your usual medication, unless your own doctor told you otherwise.

Anti-TTG (Tissue Transglutaminase): when is testing worthwhile?

According to the NVKC, anti-tTG is measured when a doctor wants to find out whether coeliac disease is causing the symptoms. According to Thuisarts, when someone has already stopped eating gluten, the doctor can ask them to eat gluten again for a while.

Anti-TTG (Tissue Transglutaminase): symptoms of a high or low value

Low Levels

According to the NVKC, a negative anti-tTG gives a small chance of coeliac disease. For a "coeliakie diagnostisch" request, Unilabs runs a total IgA test when IgA-tTG is undetectable, provided the system detects no background noise, and with an unmeasurably low total IgA it automatically runs an IgG test that Unilabs calls IgG-DPG.

High Levels

After a positive anti-tTG, the NVKC rates the chance of coeliac disease as high. According to Thuisarts, besides gut complaints coeliac disease can also give inflamed joints, reduced fertility and itchy patches on the skin, the last mainly in adults.

Anti-TTG (Tissue Transglutaminase): causes of a low or high value

What lowers the value

  • Too little IgA antibody production

    The anti-tTG test measures antibodies of the IgA type, and a negative result is followed by checking whether the patient can make IgA antibodies in sufficient amounts.

What raises the value

  • Coeliac disease

    When anti-tTG is detected, it usually points to hypersensitivity to gluten (coeliac disease), and the chance of coeliac disease is then high.

Anti-TTG (Tissue Transglutaminase): lifestyle and this value

See your GP with a positive anti-tTG. According to Thuisarts, with coeliac disease the parents, brothers and sisters and children have a greater chance of having it too, and blood tests can show whether someone has coeliac disease.

Anti-TTG (Tissue Transglutaminase): frequently asked questions

How big is the chance of coeliac disease when a family member has it?

According to Thuisarts, in people with a parent, brother or sister with coeliac disease, the condition anti-tTG points to, the chance is about 10 in 100, against 1 in 100 people in the Netherlands.

Anti-TTG (Tissue Transglutaminase): sources

  1. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  2. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  3. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  4. NVKC, Alles over testen: Anti-TTG, allesovertesten.nl, geraadpleegd 2026-10-16 (retrieved 2026) allesovertesten.nl

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Anti-TTG (Tissue Transglutaminase)

€111,-