Laboratory Tests for a Pregnant Patient with Post-Concussion Syndrome, POTS, and Digestive Complaints
For a pregnant patient with post-concussion syndrome, POTS, and digestive complaints, a comprehensive laboratory panel should include complete blood count, comprehensive metabolic panel, thyroid function tests, serum tryptase levels, and iron studies.
Initial Laboratory Assessment
Basic Laboratory Tests
- Complete blood count (CBC)
- Comprehensive metabolic panel (CMP) including:
- Electrolytes
- BUN/creatinine ratio (to assess hydration status)
- Liver function tests
- Glucose
- Urinalysis
Thyroid Function Tests
- Thyroid-stimulating hormone (TSH)
- Free T4
- Consider thyroid peroxidase (TPO) antibodies 1
Autonomic Dysfunction/POTS-Specific Tests
- Serum tryptase levels (baseline and during symptom flares) to assess for mast cell activation syndrome (MCAS), which can exacerbate POTS symptoms 2, 1
- Consider urinary N-methylhistamine, leukotriene E4, and 11b-prostaglandin F2 if MCAS is strongly suspected 2
Iron Studies
- Serum ferritin
- Serum iron
- Total iron binding capacity
- Transferrin saturation 1
Pregnancy-Specific Laboratory Tests
Routine Pregnancy Tests
- Blood type and Rh status
- Indirect Coombs test to exclude alloimmunization 2
- Kleihauer-Betke test if trauma history is significant to quantify maternal-fetal hemorrhage 2, 3
Additional Tests
- Serum fibrinogen (particularly important in trauma patients) 3
- Amniotic fluid alpha-fetoprotein (AFAFP) if invasive testing is performed 2
Digestive Complaint-Specific Tests
Celiac Disease Screening
- Tissue transglutaminase antibodies (tTG-IgA)
- Total IgA level 2
Other GI Tests
- Inflammatory markers (C-reactive protein, erythrocyte sedimentation rate)
- Consider disaccharidase testing if symptoms suggest intolerance 2
Nutritional Assessment
- Vitamin B12 and folate levels
- Vitamin D level 1
- Mean corpuscular volume (MCV) to screen for potential thalassemia if appropriate based on ethnicity 2
Special Considerations
Post-Concussion Monitoring
- While no specific laboratory tests exist exclusively for post-concussion syndrome, monitoring the above parameters is important as autonomic dysfunction can worsen following concussion 4, 5
POTS and Pregnancy
- POTS symptoms may worsen during pregnancy due to physiologic changes in blood volume and vascular tone
- More frequent monitoring of electrolytes and hydration status may be necessary 6
Joint Hypermobility Connection
- If joint hypermobility is suspected (common in POTS patients), consider additional screening for connective tissue disorders 7
Monitoring Frequency
- TSH should be monitored every 4 weeks until stable, then once per trimester during pregnancy 1
- Tryptase levels should be checked both at baseline and during symptom flares 2, 1
- Other tests should be repeated based on clinical symptoms and initial results
Cautions and Pitfalls
- Avoid unnecessary radiation exposure, but do not delay indicated imaging due to pregnancy concerns 3
- Be aware that normal laboratory values change during pregnancy (particularly for thyroid function)
- Consider that POTS symptoms may be misattributed to normal pregnancy changes or anxiety
- Remember that digestive complaints in pregnancy with POTS may have multiple etiologies requiring different management approaches
This laboratory assessment provides a structured approach to evaluating the complex presentation of post-concussion syndrome, POTS, and digestive complaints in a pregnant patient, focusing on tests that will impact morbidity, mortality, and quality of life.