From the Guidelines
Laboratory tests for patients with lymphedema should include complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid function tests, and inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), as these help evaluate for underlying causes and comorbidities. The selection of laboratory tests should be tailored to the individual patient's clinical presentation and history. In cases where secondary lymphedema is suspected, additional testing may be warranted, such as serum protein electrophoresis to rule out paraproteinemia, antinuclear antibody (ANA) testing for autoimmune conditions, and filariasis serology in endemic regions 1.
When considering the management and diagnosis of lymphedema, it's crucial to differentiate between primary and secondary lymphedema, as this distinction can significantly impact treatment and management strategies. Primary lymphedema is often associated with genetic predispositions, while secondary lymphedema can result from various factors including surgery, radiation, infection, or trauma. The presence of certain biomarkers or abnormalities in laboratory tests can provide valuable insights into the underlying cause of lymphedema, guiding appropriate treatment interventions.
Given the potential for lymphedema to be a complication of cancer treatment, guidelines such as those from the American Society of Clinical Oncology (ASCO) recommend assessment for lymphedema in head and neck cancer survivors using specific criteria, with referral to rehabilitation specialists for treatment as needed 1. This approach underscores the importance of a multidisciplinary care plan for patients with lymphedema, incorporating both the management of the condition itself and the addressing of any underlying or contributing factors.
In clinical practice, the management of lymphedema involves a comprehensive approach that includes not only laboratory testing but also physical therapy, lifestyle modifications, and sometimes pharmacological interventions. The goal of treatment is to reduce swelling, prevent infection, and improve the patient's quality of life. By prioritizing the assessment and management of lymphedema based on the most recent and highest quality evidence, healthcare providers can offer patients the best possible outcomes in terms of morbidity, mortality, and quality of life.
Key considerations in the laboratory workup for lymphedema include:
- Complete blood count (CBC) to evaluate for signs of infection or inflammation
- Comprehensive metabolic panel (CMP) to assess for metabolic abnormalities
- Thyroid function tests, as thyroid dysfunction can contribute to or exacerbate lymphedema
- Inflammatory markers such as CRP and ESR to monitor for underlying inflammatory processes
- Additional tests as indicated by the patient's clinical presentation and history, such as serum protein electrophoresis or ANA testing.
Ultimately, the specific laboratory tests ordered should be guided by a thorough patient evaluation and an understanding of the potential underlying causes of lymphedema, with the aim of providing personalized and effective care.
From the Research
Laboratory Tests for Lymphedema
To determine the underlying diagnosis of lymphedema, several laboratory tests can be considered:
- Blood tests to evaluate kidney function, such as potassium, sodium, and creatinine clearance 2
- Serum albumin levels, although hypoalbuminaemia is not directly related to oedema formation 3
- Thyroid function tests, as hypothyroidism can cause myxedema, a type of edema 4
Imaging Studies
Imaging studies can also be useful in assessing lymphedema:
- Whole-body lymphangioscintigraphy (LAS) is a preferred method for initial assessment of the peripheral lymphatic system 5
- This technique can help identify obstructive patterns, hypoplasia, or aplasia of lymphatic trunks and nodes
Other Considerations
In addition to laboratory tests and imaging studies, a systematic approach to determine the underlying diagnosis of lymphedema is warranted 6
- This may include evaluating for venous obstruction, increased capillary permeability, and increased plasma volume secondary to sodium and water retention 6