From the Guidelines
Bloodwork for anorexia nervosa should include a complete blood count and a comprehensive metabolic panel, including electrolytes, liver enzymes, and renal function tests, as recommended by the American Psychiatric Association (1). When evaluating a patient with a possible eating disorder, it is essential to assess the physical impact of malnutrition and starvation on the body. The initial laboratory assessment should include a range of tests to identify potential abnormalities, such as:
- Low white blood cell count (leukopenia)
- Anemia
- Low potassium (hypokalemia)
- Low sodium (hyponatremia)
- Elevated liver enzymes
- Low blood glucose
- Abnormal thyroid function These tests are crucial for monitoring the severity of the condition and guiding treatment decisions. Additional tests may be necessary, such as an electrocardiogram (ECG) to check for heart rhythm abnormalities, particularly in patients with a restrictive eating disorder, severe purging behavior, or those taking medications that may affect heart function (1). Regular monitoring through bloodwork is essential throughout the recovery process, as refeeding can sometimes cause additional complications like refeeding syndrome, characterized by dangerous shifts in fluids and electrolytes. Key aspects of the initial evaluation include:
- Weighing the patient and quantifying eating and weight control behaviors
- Identifying co-occurring health conditions, including co-occurring psychiatric disorders
- Conducting a comprehensive review of systems
- Assessing vital signs, including temperature, resting heart rate, blood pressure, orthostatic pulse, and orthostatic blood pressure (1).
From the Research
Anorexia Nervosa Bloodwork
- Anorexia nervosa is a debilitating illness that affects mostly females and their families, with multiple physiologic disturbances that can be life-threatening 2
- Assessment of anorexia nervosa is essential in research and can dramatically enhance clinical practice, with standardized assessment being crucial 3
- Bloodwork for anorexia nervosa may include liver function tests, which can be abnormal due to severe malnutrition before refeeding has commenced, and may improve as refeeding occurs 4
- Refeeding syndrome is a potential complication of anorexia nervosa treatment, characterized by electrolyte and fluid abnormalities, and can affect multiple organ systems, including the liver 5
- Abnormal liver function tests in anorexia nervosa patients can be an atypical manifestation of refeeding syndrome, and may normalize upon resolution of the syndrome 5
Key Findings
- Initial assessment and early treatment options for anorexia nervosa should focus on nutritional rehabilitation and engagement of the family system 6, 2
- Comprehensive assessment of anorexia nervosa should include understanding of the physiologic, developmental, and psychiatric status of the individual, as well as engagement of the family system 2
- Liver function test abnormalities in anorexia nervosa can be caused by severe malnutrition or refeeding syndrome, and should be monitored closely during treatment 4, 5