From the Guidelines
A basic workup for Inflammatory Bowel Disease (IBD) should include a full blood count, serum C-reactive protein level, erythrocyte sedimentation rate level, serum electrolytes, liver enzymes level, serum albumin, renal function, and faecal calprotectin level, as well as stool cultures and toxin test for Clostridium difficile to rule out infectious diseases. According to the most recent and highest quality study 1, these laboratory tests are essential to assess Crohn’s disease or Ulcerative colitis disease activity and to exclude any infectious diseases. The study recommends performing the following laboratory tests:
- a full blood count, including haemoglobin, leukocytes count and platelet count;
- serum C-reactive protein level,
- erythrocyte sedimentation rate level,
- serum electrolytes,
- liver enzymes level,
- serum albumin,
- renal function and
- faecal calprotectin level, when it is possible. Additionally, it is mandatory to exclude any infectious diseases by performing blood-, stool cultures and toxin test for Clostridium difficile, as stated in the study 1. This approach is supported by another study 1, which also emphasizes the importance of routine laboratory investigations, including complete blood count, liver profile, albumin, iron studies, renal function, and vitamin B12, as well as assessing CRP as a marker of inflammation and faecal calprotectin as a marker of intestinal inflammation. However, the most recent study 1 provides a more comprehensive and up-to-date recommendation for the basic workup of IBD. Key points to consider in the basic workup for IBD include:
- Assessing inflammation and disease activity through laboratory tests
- Ruling out infectious causes of symptoms
- Evaluating nutritional status and disease severity
- Using a combination of laboratory tests to provide a comprehensive assessment of the patient's condition.
From the Research
Basic Lab Workup for IBD
The basic lab workup for Inflammatory Bowel Disease (IBD) includes various tests to assess disease activity, monitor medication response or toxicity, and detect nutritional deficiencies.
- Complete blood count (CBC) to evaluate anemia, which is a common complication of IBD 2, 3, 4, 5
- Iron indices, such as ferritin, to diagnose iron deficiency anemia 4, 5
- Inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), to assess disease activity 2, 6
- Vitamin B12 and folate levels to detect deficiencies 3, 4
- Liver function tests to monitor for potential medication toxicity 6
- Electrolyte panel to evaluate for electrolyte imbalances 6
Additional Tests
Additional tests may be ordered based on the patient's clinical presentation and medical history.
- Therapeutic drug monitoring (TDM) to optimize medication dosing and minimize toxicity 6
- Infectious disease testing, such as tuberculosis and hepatitis B virus, to screen for potential infections before starting immunosuppressive therapy 6
- Endoscopic and histopathological examination to assess disease activity and extent 6
Importance of Lab Tests
Lab tests play a crucial role in the management of IBD, as they help clinicians diagnose and monitor disease activity, detect nutritional deficiencies, and optimize medication therapy 2, 6, 3, 4, 5. Regular lab testing can help identify potential complications early on, allowing for prompt intervention and improved patient outcomes.