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Post-Bariatric Surgery Micronutrient Profile

CPT 82306; 82310; 82390; 82525; 82607; 82728; 82746; 83540; 83550; 84238; 84425; 84590; 84630; 85025
Synonyms
  • Weight Management

Test Details

Methodology

See individual test components.

Result Turnaround Time

3 - 5 days

Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.

Test Includes

Vitamin B1, vitamin B12, methylmalonic acid, folate, ferritin, iron and total iron-binding concentration (TIBC), soluble transferrin receptor, 25-hydroxyvitamin D, vitamin A, zinc, copper, ceruloplasmin, calcium, complete blood count (CBC)

Use

Obesity, associated with a multitude of co-morbid conditions, is a serious health condition impacting a significant number of patients in the U.S. Per the Centers for Disease Control and Prevention (CDC), the prevalence of obesity in the U.S. increased from 30.5% in 1999-2000 to 41.9% in 2017- March 2020.1 Currently, there is great emphasis on being overweight and obesity as a disease, with societies providing guidance on the use of newly available pharmacologic therapies as well as bariatric surgical procedures to decrease the burden.

Depending upon the type of bariatric surgery performed, deficiencies of micronutrients and some vitamins may ensue, and recommendations are to evaluate these parameters prior to surgery and at least annually thereafter.

Limitations

See individual test components.

Footnotes

1. Adult Obesity Facts. Centers for Disease Control and Prevention (CDC) website: https://www.cdc.gov/obesity/data/adult.html. Updated May 17, 2022. Accessed Dec 19, 2023.
2. Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Endocr Pract. 2019 Dec;25(12):1346-1359.31682518
3. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022 Dec;18(12):1345-1356.36280539

References

Banerjee ES, Schroeder R, Harrison TD. Metabolic Surgery for Adult Obesity: Common Questions and Answers. Am Fam Physician. 2022 Jun 1:105(6):593-601.35704821

Custom Additional Information

Per 2019 guidelines,2 bariatric surgery is advised under the following conditions in adult populations:

Patients with a body mass index ≥40 kg/m2 without co-existing medical problems and for whom bariatric procedures would not be associated with excessive risk are eligible for a bariatric procedure (Grade A; BEL 1).

Patients with a body mass index (BMI) ≥35 kg/m2 and one or more severe obesity-related complications remediable by weight loss, including type 2 diabetes (T2D), high risk for T2D (insulin resistance, prediabetes and/or metabolic syndrome), poorly controlled hypertension, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, obstructive sleep apnea, osteoarthritis of the knee or hip and urinary stress incontinence, should be considered for a bariatric procedure (Grade C; BEL 3).

Patients with the following comorbidities and BMI ≥35 kg/m2 may also be considered for a bariatric procedure, hypoventilation syndrome and Pickwickian syndrome after a careful evaluation of operative risk: idiopathic intracranial hypertension; gastroesophageal reflux disease; severe venous stasis disease; impaired mobility due to obesity and considerably impaired quality of life (Grade C; BEL 3).

Patients with body mass index 30 to 34.9 kg/m2 and type 2 diabetes with inadequate glycemic control despite optimal lifestyle and medical therapy should be considered for a bariatric procedure; current evidence is insufficient to support recommending a bariatric procedure in the absence of obesity (Grade B; BEL 2).

The body mass index criterion for bariatric procedures should be adjusted for ethnicity (e.g., 18.5 to 22.9 kg/m2 is normal range, 23 to 24.9 kg/m2 is overweight and ≥25 kg/m2 is obesity for Asians) (Grade D).

Bariatric procedures should be considered to achieve optimal outcomes regarding health and quality of life when the amount of weight loss needed to prevent or treat clinically significant ORC cannot be obtained using only structured lifestyle change with medical therapy (Grade B; BEL 2).

Grading of these guidelines corresponds to the following levels of recommendation (BEL: best evidence level):

• Grade A / BEL 1 – strong recommendation

• Grade B / BEL 2 – intermediate recommendation

• Grade C / BEL 3 – weak recommendation

• Grade D – no conclusive evidence or expert opinion

The following indications for bariatric surgery3 are suggested by the 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO):

• Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) ≥35 kg/m2, regardless of presence, absence or severity of co-morbidities.

• MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.

• BMI thresholds should be adjusted in the Asian population such that a BMI ≥25 kg/m2 suggests clinical obesity, and individuals with BMI ≥ 27.5 kg/m2 should be offered MBS.

Specimen Requirements

Specimen

Serum, whole blood, plasma

Volume

5 mL serum, 8 mL whole blood, 4 mL plasma

Container

Gel-barrier tube, polypropylene screw-capped transfer tube, trace metal free transfer tube, lavender-top (EDTA) tube

Storage Instructions

See individual test components.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 001016 Calcium mg/dL 17861-6
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 001347 Iron Bind.Cap.(TIBC) ug/dL 2500-7
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 001348 UIBC ug/dL 2501-5
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 001339 Iron ug/dL 2498-4
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 011362 Iron Saturation % 2502-3
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 004598 Ferritin ng/mL 2276-4
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 001560 Ceruloplasmin mg/dL 2064-4
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 142004 Vitamin A ug/dL 2923-1
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 121188 Vit. B1, Whole Blood nmol/L 32554-8
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 001503 Vitamin B12 pg/mL 2132-9
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 002020 Folate (Folic Acid), Serum ng/mL 2284-8
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 081953 Vitamin D, 25-Hydroxy ng/mL 62292-8
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 143307 Soluble Transferrin Receptor nmol/L 33210-6
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 001586 Copper, Serum or Plasma ug/dL 5631-7
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 001800 Zinc, Plasma or Serum ug/dL 5763-8
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 005025 WBC x10E3/uL 6690-2
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 005033 RBC x10E6/uL 789-8
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 005041 Hemoglobin g/dL 718-7
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 005058 Hematocrit % 4544-3
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015065 MCV fL 787-2
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015073 MCH pg 785-6
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015081 MCHC g/dL 786-4
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 105007 RDW % 788-0
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015172 Platelets x10E3/uL 777-3
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015107 Neutrophils % 770-8
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015123 Lymphs % 736-9
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015131 Monocytes % 5905-5
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015149 Eos % 713-8
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015156 Basos % 706-2
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 115398 Immature Cells N/A
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015909 Neutrophils (Absolute) x10E3/uL 751-8
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015917 Lymphs (Absolute) x10E3/uL 731-0
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015925 Monocytes(Absolute) x10E3/uL 742-7
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015933 Eos (Absolute) x10E3/uL 711-2
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015941 Baso (Absolute) x10E3/uL 704-7
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015108 Immature Granulocytes % 71695-1
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015911 Immature Grans (Abs) x10E3/uL 53115-2
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015945 NRBC % 58413-6
259129 Ca+Fe+CBC/D/Plt+TIBC+Fer+B1... 015180 Hematology Comments: 18314-5
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code001016
Result Code NameCalcium
UofMmg/dL
Result LOINC17861-6
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code001347
Result Code NameIron Bind.Cap.(TIBC)
UofMug/dL
Result LOINC2500-7
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code001348
Result Code NameUIBC
UofMug/dL
Result LOINC2501-5
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code001339
Result Code NameIron
UofMug/dL
Result LOINC2498-4
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code011362
Result Code NameIron Saturation
UofM%
Result LOINC2502-3
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code004598
Result Code NameFerritin
UofMng/mL
Result LOINC2276-4
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code001560
Result Code NameCeruloplasmin
UofMmg/dL
Result LOINC2064-4
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code142004
Result Code NameVitamin A
UofMug/dL
Result LOINC2923-1
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code121188
Result Code NameVit. B1, Whole Blood
UofMnmol/L
Result LOINC32554-8
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code001503
Result Code NameVitamin B12
UofMpg/mL
Result LOINC2132-9
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code002020
Result Code NameFolate (Folic Acid), Serum
UofMng/mL
Result LOINC2284-8
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code081953
Result Code NameVitamin D, 25-Hydroxy
UofMng/mL
Result LOINC62292-8
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code143307
Result Code NameSoluble Transferrin Receptor
UofMnmol/L
Result LOINC33210-6
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code001586
Result Code NameCopper, Serum or Plasma
UofMug/dL
Result LOINC5631-7
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code001800
Result Code NameZinc, Plasma or Serum
UofMug/dL
Result LOINC5763-8
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code005025
Result Code NameWBC
UofMx10E3/uL
Result LOINC6690-2
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code005033
Result Code NameRBC
UofMx10E6/uL
Result LOINC789-8
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code005041
Result Code NameHemoglobin
UofMg/dL
Result LOINC718-7
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code005058
Result Code NameHematocrit
UofM%
Result LOINC4544-3
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015065
Result Code NameMCV
UofMfL
Result LOINC787-2
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015073
Result Code NameMCH
UofMpg
Result LOINC785-6
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015081
Result Code NameMCHC
UofMg/dL
Result LOINC786-4
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code105007
Result Code NameRDW
UofM%
Result LOINC788-0
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015172
Result Code NamePlatelets
UofMx10E3/uL
Result LOINC777-3
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015107
Result Code NameNeutrophils
UofM%
Result LOINC770-8
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015123
Result Code NameLymphs
UofM%
Result LOINC736-9
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015131
Result Code NameMonocytes
UofM%
Result LOINC5905-5
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015149
Result Code NameEos
UofM%
Result LOINC713-8
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015156
Result Code NameBasos
UofM%
Result LOINC706-2
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code115398
Result Code NameImmature Cells
UofM
Result LOINCN/A
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015909
Result Code NameNeutrophils (Absolute)
UofMx10E3/uL
Result LOINC751-8
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015917
Result Code NameLymphs (Absolute)
UofMx10E3/uL
Result LOINC731-0
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015925
Result Code NameMonocytes(Absolute)
UofMx10E3/uL
Result LOINC742-7
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015933
Result Code NameEos (Absolute)
UofMx10E3/uL
Result LOINC711-2
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015941
Result Code NameBaso (Absolute)
UofMx10E3/uL
Result LOINC704-7
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015108
Result Code NameImmature Granulocytes
UofM%
Result LOINC71695-1
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015911
Result Code NameImmature Grans (Abs)
UofMx10E3/uL
Result LOINC53115-2
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015945
Result Code NameNRBC
UofM%
Result LOINC58413-6
Order Code259129
Order Code NameCa+Fe+CBC/D/Plt+TIBC+Fer+B1...
Order Loinc
Result Code015180
Result Code NameHematology Comments:
UofM
Result LOINC18314-5
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115400 Bands % 35332-6
Reflex 1
Order Code115399
Order NameImmature Cells
Result Code115400
Result NameBands
UofM%
Result LOINC35332-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115401 Metamyelocytes % 28541-1
Reflex 1
Order Code115399
Order NameImmature Cells
Result Code115401
Result NameMetamyelocytes
UofM%
Result LOINC28541-1
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115403 Myelocytes % 26498-6
Reflex 1
Order Code115399
Order NameImmature Cells
Result Code115403
Result NameMyelocytes
UofM%
Result LOINC26498-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115404 Promyelocytes % 26498-6
Reflex 1
Order Code115399
Order NameImmature Cells
Result Code115404
Result NamePromyelocytes
UofM%
Result LOINC26498-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115405 Blasts/blast like cells % 26498-6
Reflex 1
Order Code115399
Order NameImmature Cells
Result Code115405
Result NameBlasts/blast like cells
UofM%
Result LOINC26498-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115406 Megakaryocytes % 19252-6
Reflex 1
Order Code115399
Order NameImmature Cells
Result Code115406
Result NameMegakaryocytes
UofM%
Result LOINC19252-6
Reflex Table for Immature Cells
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115399 Immature Cells 115265 Other, Lineage Uncertain % 55433-7
Reflex 1
Order Code115399
Order NameImmature Cells
Result Code115265
Result NameOther, Lineage Uncertain
UofM%
Result LOINC55433-7