Laboratory test | When on PN | When on full enteral feeds |
CBC with RBC indices/differential, reticulocyte count | Every 1 to 3 months or as clinically indicated (More frequent monitoring with blood loss, microcytic anemia, abnormal iron studies, or parenteral iron use) | After PN is discontinued¶, then every 6 to 12 months (More frequent monitoring with blood loss, microcytic anemia, abnormal iron studies, or enteral iron use) |
Iron studies (iron, ferritin, TIBC, transferrin saturation), with CRP* | ||
PN profile:
| When PN is initiated, weekly until stable, and then with significant changes in PN formulation or volume For patients on stable PN, these labs should be monitored every 1 to 3 months | After PN is discontinued¶, then every 6 to 8 months, depending on clinical status |
Hepatic panel:
| When PN is initiated, then weekly until stable For patients on stable PN, monitor every 1 to 3 months | Annually for patients with history of IFALD |
Copper, zinc, selenium (measure in conjunction with CRP) | Measure 30 days after PN initiation, then every 6 months (If level is low, or if making changes to dosing of these trace minerals in PN, repeat every 2 to 3 months. Monitor more frequently in patients with persistent neutropenia or anemia) Measure copper and ceruloplasmin with CRP and CBC in patients with signs of copper deficiencyΔ | Measure zinc after PN is discontinued¶, then at least annually Measure copper and ceruloplasmin with CRP in patients with signs of copper deficiencyΔ |
PT, INR (as an index of vitamin K sufficiency)◊ | Every 6 months (Monitor more frequently in patients with gastrointestinal bleeding, bacterial overgrowth, or cholestasis) | After PN is discontinued¶, then at least annually (Monitor more frequently in patients with gastrointestinal bleeding, bacterial overgrowth, or cholestasis) |
Monitor fat-soluble vitamin status:
| Annually (Check every 3 to 6 months in patients with evidence of deficiency, on enteral supplementation, or with chronic liver disease or cholestasis) | After PN is discontinued¶, then at least annually (Check every 3 to 6 months in patients with evidence of deficiency, those on enteral supplementation, or those with chronic liver disease or cholestasis) |
Serum vitamin B12 | Annually | After PN is discontinued¶, then every 6 to 12 months, especially in patients who had resection of the distal ileum or persistent macrocytic anemia§ |
Essential fatty acid panel | Measure every 3 to 6 months in patients on lipid restriction (ie, total fat intake ≤1 g/kg/day for >10 to 14 days) | Measure if there are clinical signs of essential fatty acid deficiency such as poor growth or rash |
Aluminum, carnitine profile | Measure 30 days after PN initiation, then every 6 months | Not necessary |
Alpha-fetoprotein level | Annually for patients with a history of cirrhosis related to IFALD | Annually for patients with history of cirrhosis related to IFALD |
Chromium, manganese | Annually (Measure more frequently in patients with poor glycemic control [which may be caused by chromium deficiency]) | Generally not necessary |
Urine sodium | Consider every 6 months or more frequently in patients with poor weight gain, those with high ostomy output, or those on enteral NaCl supplementation | Consider every 6 months or more frequently in patients with poor weight gain, those with high ostomy output, or those on enteral NaCl supplementation |