What labs do you follow

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What labs do you regularly follow to understand the course of crohn's?

I had to ask twice in two visits to have a fecal cal test done for M. Second time worked and we are awaiting results. Also, when she was in the hospital wed/thur she had CRP and ESR (are those right?) done.

I haven't written the values down yet, but plan to track them down and begin to know the meanings, etc. which I don't know at all.

Am I on the right track?
 
A seems to routinely have amylase & lipase, GGT, CBC, hepatic panel, metabolic panel and CRP. We don't do fecal cal regularly because our insurance fights that one and it is over $200.

Definitely curious to see what other doctors are doing.
 
CBC, tot protein albumin, CRP + (liver function tests to follow meds)
My son's never had a calprotectin.
 
CBC, inflammatory markers (CRP, ESR), Liver function, Urea & Electrolytes, Ferritin, are all done at almost every blood test

B12 tested annually.

Vit D was tested every six months by ped GI but has not been tested since transferring to adult GI (almost a year).

No FC done.

MREs have been done approx. every six or seven months thus far.
 
Matt has bloods done every two months due to taking Imuran and I will give the reasons why. He has a standing order so gets everything requested done:

So baseline bloods due to medication are -

- FBC (Full Blood Count, your equivalent is CBC) - Tests red and white cell levels as Imuran can suppress white cell counts. Also can indicate other issues that may be present such as bleeding/deficiencies or infection if haemoglobin drops, platelets rise or white cells counts rise.

- LFT's (Liver Function Tests) - Enzyme counts will indicate how well the liver is coping with metabolising medication.

- UEC's (Urea Creatinine & Electrolytes) - Another baseline blood that useful to monitor kidney function and also levels of electrolytes such as Potassium which can drop in those with CD that have ileal involvement if disease is active.

^^^^As far as I am aware, in the US LFT's and UEC's are combined into what you call CMP?

- Inflammatory Markers - CRP (C-Reactive Protein) & ESR (Erythrocyte Sedimentation Rate). ESR is an older test that is not as sensitive to changes as CRP is. ESR can be a better indicator in Arthritic diseases but CRP is generally the preferred test in IBD due to its higher level of sensitivity and therefore quicker response time in showing both increase in disease activity and response to treatment.

- Iron Studies - Gives a good overview of how iron is being absorbed and stored and therefore monitors for iron deficiency. If deficiency is present it will allow a better interpretation of what is the causing the anaemia.

The following tests I have done because my son has Ileal disease and has also had an ileocaecal resection. If the small bowel is where your son's disease is active then there is the real potential to have deficiencies in the following due to malabsorption. For those with large bowel disease only these would normally not present a problem:

- B12. The Terminal Ileum is the only area in the bowel where this is absorbed. If there is extensive disease/scarring in this area or you have had a resection this needs to be monitored at least annually but I would prefer no more than 6 monthly. Deficiency in B12 is dangerous and will lead to pernicious anaemia.
- Vitamin D
- Zinc
- Magnesium

_______________________________________


Specifically relating to my son, we have not had faecal calprotectin done or metabolites but they are on the GI's agenda at the next consult.

Dusty. :)
 
Greypup, thank you for asking this question. I'm just learning too. Dustykat, thanks so much for the explanation of those tests. It is really helpful to see what other docs are ordering.

We have a standing req form for bloodwork every 2 wks for my son. The form was completed when he started Imuran, but that drug has since been stopped and MTX started. No changes were made to the form when he started MTX though.

currently-CBC; ESR; Albumin; BUN/Urea; Creatinine; Amylase; GGT; ALK PHOS; ALT/SGPT; AST/SGOT.

My son had a lot of bloodwork done when he was first dx'd, which also showed anemia, low hemoglobin, etc, but I don't know the specifics.
 
These are what would be considered base line bloods for any person regardless of age or condition.

Australia Full Blood Count. Is normally listed as Haematology and includes the following:

Haemoglobin (Hb)
Red Cell Count (RCC)
Haematocrit (Hct)
MCV
MCH
MCHC
RDW
White Cell Count
Neutrophils (Neut)
Lymphocytes (Lymph)
Monocytes (Mono)
Eosinophils (Eos)
Basophils (Baso)
Platelets
ESR - Will be listed here if requested.

Australia LFT's and UEC's. All results will be listed under either Chemistry, Serum Chemistry or Biochemistry and will include the following:

Sodium (Na)
Potassium (K)
Chloride (Cl)
Bicarbonate (HCO3)
Anion Gap (An Gap)
Urea
Creatinine (Creat)
Estimated Glomerular Filtration Rate (eGFR)
Urate
Bilirubin (Bili)
AST
ALT
Gamma GT (GGT)
LDH
Alk Phos
Protein
Albumin
Globulin
Some labs will do the following as a matter of course, hospitals tend to, but others only if requested:
Calcium (Ca)
Corr Ca (Corrected Calcium)
Phosphate (PO4)
Magnesium (Mg)

This has been lifted, and edited, from the forum wiki:

+FBC (Full Blood Count) or CBC (Complete Blood Count). This measures the red and white blood cells, and platelets in the blood. It is standard whenever blood is tested.
+Haemoglobin / Hemoglobin (U.S) NRR 13.2-16.2 gm/dL (Male) 12.0-15.2 gm/dL (Female) - used in the red blood cells to carry oxygen around the body. Low haemoglobin indicates anaemia, which can have several causes.
+Platelets NRR 140-450x103/µL - helps the blood to clot. Too low indicates you are at risk of excessive bleeding, and is called Thrombocytopenia. A platelet count that is too high is called Thrombocythemia and can cause Clubbed Fingers and increased risk of Blood Clots.
+MCH NRR 26-34 pg - Mean corpsicle haemoglobin. The average amount of haemoglobin in each red blood cell. Too low can indicate iron deficiency anaemia.
+MCHC NRR 31-35 gm/dL - Mean corpsicle haemoglobin concentration. Whether the red blood cell has the right amount of haemoglobin for its size. In cases of iron deficiency anaemia, this result may be normal.
+HCT NRR 40-52% (Male) 37-46% (Female) 31-43% (Child) - Haematocrit. Measures the percentage of red blood cells in whole blood. It is an indicator of anaemia, bleeding and nutritional deficiencies (B12, Iron and Folate).
+MCV NRR 82-102 fL (Male) 78-101 fL (Female) - Mean corpsicle volume. Whether the red blood cells are the right size. Too low can indicate iron deficiency anaemia.
+RBC NRR 4.3-6.2x106/µL (Male) 3.8-5.5x106/µL (Female) 3.8-5.5x106/µL (Infant/Child) - Red blood count. The number of red blood cells in the blood. This result may be normal in iron deficiency anaemia.
+WBC NRR 4.1-10.9x103/µL - White blood count. Too low indicates the immune system is suppressed. Too high can indicate infection. This measures the different types of white blood cells. Numbers given are absolutes (that is the actual number of each type present rather than as a proportion of all the white blood cells). If the overall WBC is too high or low, the numbers of each type of white blood cell can help the physician to determine the cause.
+Neutrophils NRR 2.0-7.5 x 109/L - high levels may indicate acute infection, stress or Rheumatoid Arthritis. Low levels may be due to widespread bacterial infection, influenza or caused as side effect of some of the drugs used to treat IBD
+Lymphocytes NRR 1.5-4.0 x 109/L - raised levels may be due to chronic infection, viral infection or infectious hepatitis. Low levels may be caused by sepsis or from the side effects of some of the drugs used to treat IBD.
+Monocytes NRR 0.2-0.8 x 109/L - These can be raised through stress, inflammation, or immune disorders. They can be low after treatment with glucocorticosteroids (such as prednisolone).
+Eosinophils NRR 0.04-0.4 x 109/L - If these are too high it may indicate the presence of an eosinophilic disorder, which can have similar symptoms to an IBD.
+Basophils NRR <0.1 x 109/L - levels increase when there is inflammation present caused by things like an allergic reaction or Asthma.
+Erythrocyte sedimentation rate. NRR male <50 years 1-7 mm/hour >50 years 2-10 mm/hour, female <50 years 3-9 mm/hour >50 years 5-15 mm/hour. How 'sticky' the proteins in the blood are. Too high indicates acute inflammation in the body. ESR changes quite quickly, therefore can be used to assess the effectiveness of medications. However ESR can be raised by other inflammation in the body (non-IBD related).

+Liver function tests. Assesses how well the liver is functioning. Used to monitor patients taking azathioprine, to ensure the medication is not damaging the liver.
+ALT NRR 5-40 U/L - Alanine Transaminase is an enzyme that is released into the blood when the liver is damaged or diseased.
+Gamma GT NRR males <50 U/L, females <30 U/L - Gamma-glutamyl transpeptidase, detects diseases of the liver and bile ducts.
+Total Bilirubin NRR 2-20 mol/L - this is a product formed from destroying old red blood cells.
+Total Alk. Phos. NRR adult, non pregnant 25-100 U/L, growing children 70-300 U/L - Alkaline Phosphatase, helps to detect liver disease.
+Albumin NRR 35-47 g/L - helps to detect disorders affecting the liver and kidney. Low levels can also be an indicator malnutrition, malabsorption and severe inflammation.

+Urea and Electrolytes. Used to assess kidney function.
+Sodium NRR 135-145 mmol/L - this is one of the electrolytes used within cells. It is processed from salt. Too high or low can mean kidneys are not functioning properly, that the person is suffering from dehydration, they are not absorbing salt correctly (particularly in patients with terminal ileum involvement) or the diet is too high or low in salt.
+Potassium NRR 3.8-4.9 mmol/L - this is another electrolyte used within cells. Too high or low can indicate problems with kidney function, dehydration or diet.
+Urea NRR 3.0-8.0 mmol/L - This is a waste product within the blood, that the kidneys filter out to form urine. Too high can indicate a problem with the kidneys or dehydration.
+Creatinine NRR 0.05-0.12 mmol/L - Is a waste chemical that is filtered by the kidney. High levels may indicate damage to the kidney.

http://www.crohnsforum.com/wiki/Blood-test-codes-and-results-explained

Happy reading! :study:

Dusty. :)
 

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