7
Laboratory Evaluation
Among the standard laboratory studies, several should be considered:
• HbA1c should be obtained to determine diabetes control and carbohydrate
intake.
• A complete blood count (CBC) may identify a nutritional anemia.
▶ Microcytic hypochromic anemia may indicate iron deficiency. Macrocytic anemia
may indicate folate or B12 deficiency.
• Total lymphocyte count may be a useful index of overall nutritional health.
• Albumin and prealbumin are often ignored as nutritional indicators because
they are susceptible to change by metabolic stress such as infection or
trauma and may therefore give confusing information about nutrition.
▶ Whatever the source of a low albumin and prealbumin, one should determine the
cause and address it to optimize healing.
• If the history and physical exam indicate micronutrient deficiencies, specific
tests may be ordered.
Table 3. Risk Factors for Ulcer Development
1. Medical history
2. Age
3. Weight
4. Risk assessment tool results (e.g., Braden Scale)
5. Current medications and comorbidities
6. Ability to meet nutritional needs independently
7. Oral problems (e.g., trouble chewing or swallowing)
Comorbidities
• Medical problems that interfere with eating such as bowel disorders should
be identified.
• Other disease states such as recurrent infections or cancer increase
nutritional requirements and may lead to malnutrition.
