Crohn's disease laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The laboratory findings in a patient with Crohn's disease include anemia, low albumin, elevated ESR, elevated serum alkaline phosphatase, deranged LFTs and electrolyte abnormalities

Laboratory Findings

Electrolyte and Biomarker Studies

  • A complete blood count may reveal anemia, which may be caused either by blood loss or vitamin B12 deficiency. The latter may be seen with ileitis because vitamin B12 is absorbed in the ileum.[1] It is also true in patients with ilectomy done in response to the complication. Another cause of anemia is anemia of chronic disease, characterized by its microcytic and hypochromic anemia. There are reasons in anemia, including medication in treatment of inflammatory bowel disease like azathioprine that can lead to cytopenia and sulfasalazine, which can also result in folate malabsorption, etc.
  • Erythrocyte sedimentation rate, or ESR, and C-reactive protein measurements can also be useful to gauge the degree of inflammation.[2]
Laboratory tests Findings
CBC
Iron studies
Serum Vit B12
  • Normal or low
[null Serum folate]
  • Normal or low
CMP
CRP and ESR
  • Elevated
Stool testing
  • Negative for infectious elements
Yersinia serology
  • Negative

Diagnostic criteria

Diagnosis of Crohn's disease is based on endoscopic findings and Crohns activity index score.

Endoscopic findings

Three major endoscopic findings are specific for the diagnosis of CD.

CD activity index

Eight factors, each summed up for a weighting score:

  • Number of liquid or soft stools each day for 7 days x2
  • Abdominal pain (graded from 0-3 on severity) each day for 7 days x5
  • General wellbeing, subjectively assessed from 0 (well) to 4 (terrible) each day for 7 days x7
  • Presence of complications, 1 point for each x20:
  • Arthralgia or arthritis
  • Iritis or uveitis
  • Presence of erythema nodosum, pyoderma granulosum, or aphthous ulcers
  • Anal fissures, fistulae, or abscesses
  • Fever during the past 7 days
  • Taking antidiarrheal medications x30
  • Presence of an abdominal mass (0 as none, 2 as questionable, 5 as definite) x10
  • Hematocrit <0.47 in men and <0.42 in women x6
  • Percentage deviation from standard weight x1.
  • Index values of 150 and below are associated with quiescent disease; values above that indicate active disease, and values above 450 are seen with extremely severe disease.

References

  1. Goh, Jason (2003). "Review article: nutrition and adult inflammatory bowel disease". Alimentary Pharmacology & Therapeutics. 17 (3): 307–20. doi:10.1046/j.1365-2036.2003.01482.x. PMID 12562443. 
  2. Chamouard, Patrick (April). "Diagnostic Value of C-Reactive Protein for Predicting Activity Level of Crohn's Disease". Clinical Gastroenterology and Hepatology. doi:10.1016/j.cgh.2006.02.003. PMID 16630759.  Epub ahead of print
  3. Kaila, B. (2005). "The anti-Saccharomyces cerevisiae antibody assay in a province-wide practice: accurate in identifying cases of Crohn's disease and predicting inflammatory disease". The Canadian Journal of Gastroenterology. 19 (12): 717–21. PMID 16341311. Retrieved 2006-07-02. 
  4. Israeli, E. (2005). "Anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic antibodies as predictors of inflammatory bowel disease". Gut. 54 (9): 1232–6. doi:10.1136/gut.2004.060228. PMID 16099791. 



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