Table 1.
Laboratory Monitoring of micronutrient status of post intestinal transplant patients
| a. Recommend schedule for patients on parenteral nutrition | |||
|---|---|---|---|
| Labs (deficiency status) | Initial frequency | Long term /home | Indications |
| TPN profile : Renal, Calcium, Phoshorus, Magnesium, Liver panel, Triglyceride, Bile acid, Prealbumin, glucose | With every TPN change, then weekly until stable then per MD discretion | Every 2 weeks then monthly Per MD discretion | |
| CBC with diff | Weekly initially then per MD discretion | Monthly/As indicated | Monitor anemia |
| 25 (OH) Vitamin D (< 20 ng/ml) | First level should occur after 3 months on TPN | Every 6 months; If indicated q 1 month | Deficiency |
| RBC folate (<1120 nmol/L) | Every 6 months | ||
| Iron/TIBC/Ferritin | Q 3 months; If indicated Q 1 month | Anemia with microcytosis and patient on enteral or parenteral iron | |
| Ceruloplasmin (<1 μmol/L) Copper (<80 mcg/dL) | After 30 days of TPN | Every 2 months if indicated | Cholestasis, persistent anemia, metabolic bone disease |
| Zinc (< 60 mcg/dL) Selenium | If indicated, first level should occur after 6 mo on TPN or if high ostomy output, after 30 days, and then q 3-6 months | Patients with chronic diarrhea, high ostomy output | |
| Vitamin A (<200 mcg/L) Vitamin E (<5.0 mcg/mL) Vitamin K | First level should occur after 6 months on TPN and then every 6 months | Cholestasis | |
| Chromium | If indicated | Glycemic control difficult despite GIR<15 | |
| Urine Methylmalonic acid (> | If indicated, first level at a year then Q 6 months | Ileal resection, Macrocytic anemia | |
| Serum B12 (<211 pg/mL) | If indicated, first level at a year then Q 6 months | Ileal resection, Macrocytic anemia | |
| b. Recommended schedule for patients weaned off parenteral nutrition | |||
| Labs | Frequency | Indications | |
| 25 OH Vitamin D | Q 6 months If indicated Q 3 months | On Vit D supplementation, chronic liver disease, cholestasis | |
| TPN profile | Q 6 months | ||
| CBC w/ Diff | Q 6 months | ||
| *Fe/TIBC/Ferritin | If indicated Q 6-12 months | If anemic and on supplements | |
| Urine Methylmalonic acid | If indicated, first level at a year then Q 12 months | Ileal resection, Macrocytic anemia | |
| Serum B12 | If indicated, first level at a year then Q 12 months | Ileal resection, Macrocytic anemia | |
| RBC folate | Q 6 months | Extensive resection | |
| Zinc Level (<60 mcg/dL) | Q6 months | Extensive resection | |
| Ceruloplasmin | as indicated | Persistent Neutropenia and Microcytic Anemia | |
| Serum copper | as indicated | Persistent Neutropenia and Microcytic Anemia, cholestasis | |