Blood tests to identify medical causes of neuropathy (2023)

Vondr great grandmother

The best practice is to identify and treat the causes of each person's neuropathy.

Download a list of blood tests that Massachusetts General Hospital generally recommends for patients with small fiber polyneuropathy (SFN).

Complete blood count

Measures the number of different blood cells. Abnormal results can indicate certain diseases, including vitamin B12 deficiency or blood cancer.

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Elevated glucose levels in the blood or urine indicate diabetes or prediabetes. Diabetes is the most common cause of small fiber and other types of neuropathy in developed countries. This diagnosis should always be considered in any patient diagnosed with peripheral neuropathy. Ideally, blood sugar should be measured in the morning after an overnight fast. Early symptoms of diabetes include excessive thirst and urination, weight loss or gain. BUN and creatinine measure how well your kidneys are working. Poor kidney function can cause neuropathy or affect treatment.

thyroid function test

It measures the hormones secreted by the thyroid in the throat. Both very high and very low thyroid hormone levels are associated with peripheral neuropathy. Symptoms of hypothyroidism include cold intolerance, weight gain, constipation, dry skin and hair loss, depression, weakness, and neuropathy. Symptoms of an overactive thyroid include weight loss, anxiety, lack of sleep, and neuropathy. Both diseases can be effectively treated.

Tests for vitamin levels.

Low levels of vitamin B12 (deficiency) can cause neuropathy, as well as anemia, weakness, spinal cord, and psychiatric symptoms. Methylmalonic acid levels can also be measured. Very high levels of vitamin B6 can cause neuropathy. Thiamine deficiency mainly causes motor neuropathy (weakness). These can often be corrected, which can improve or at least prevent neuropathy from getting worse.

Tests for metals and minerals.

These can be made with urine or blood. High levels of lead, mercury, thallium, zinc, and arsenic or low levels of copper have been associated with peripheral neuropathy. Patients often develop other problems as well, such as B. Thallium hair loss. Often, metal toxicities can be treated to improve the neuropathy, or at least prevent it from getting worse.

Inflammation and autoimmunity tests

This type of disease is more common in women, especially during their reproductive years, than in men. Autoimmune diseases often accompany some patients with various diseases. Systemic autoimmune diseases generally affect multiple organs in the body, including the skin, brain, kidneys, and eyes. These diseases are often treated with immunomodulatory therapies, and if a patient's neuropathy is caused by an immune disorder, it may improve as well.

erythrocyte sedimentation rate
It measures the "stickiness" of your red blood cells. A high value may indicate, among other things, inflammatory and autoimmune diseases.

Antinuclear antibodies, ANA
May indicate systemic lupus erythematosus (SLE), which often includes symptoms such as a butterfly-like rash on the face, fever, fatigue, weight loss, joint and muscle pain, skin sensitivity to sun exposure and neuropathy. Additional tests for lupus may include looking for anti-dsDNA or anti-Smith antibodies specific for SLE. Other immune disorders, including Sjogren's syndrome and rheumatoid arthritis, can also cause ANA in patients.

Anti-Ro (SS-A) y anti-La (SS-B)
Specific antibodies associated with Sjogren's syndrome. This often causes dry mouth and eyes, and various types of neuropathy are common. Patients can have Sjogren's syndrome even if these tests are negative (Sjogren's seronegative). Other tests often done to detect Sjogren's include special eye exams and a biopsy of the salivary glands in the lower lip.

IgA anti-tissue transglutaminase antibody (IgA-TTG)
The presence of these antibodies generally indicates that a patient has celiac disease. This is an autoimmune condition in which the body cannot tolerate gluten, a protein found in wheat and barley. Common symptoms include diarrhea, weight loss, anemia, and other symptoms related to nutritional deficiencies, including peripheral neuropathy. In celiac disease, inflammation can damage the lining of the intestine, leading to malabsorption of nutrients and often gastrointestinal symptoms. Fortunately, a gluten-free diet is very effective in healing the gut and improving associated symptoms.

C reactive proteins
Elevated levels may indicate infection or inflammation.

infection test

HIV tests
The US Centers for Disease Control and Prevention (CDC) recommends this for everyone ages 13 to 64, regardless of symptoms, but HIV infection is a common cause of neuropathy, so testing should be seriously considered when neuropathy is diagnosed. HIV is widespread in developing countries. Only 1 in 5 people living with HIV know their status and only 1 in 4 receive appropriate care. Approximately 1.2 million people are living with HIV in the United States, and 50,000 cases are diagnosed each year. Therefore, HIV, along with its complications, including HIV neuropathy, is a concern in the health care community. The first test is the detection of antibodies (ELISA). If it is positive, it is confirmed by a viral protein test. Early diagnosis is important because treatment can improve symptoms and reduce long-term damage. HIV patients who receive good treatment with antiretroviral drugs do well and have the same life expectancy as normal people. However, some antiretroviral drugs can cause neuropathy.

Lyme antibody test
This is what happens in Lyme disease, a bacterial infection transmitted by a tick. It is common in the northeastern United States. The first symptoms are fever, headache, fatigue, and a single specific rash. If left untreated, Lyme disease spreads to the joints, heart, and nervous system, including peripheral nerves. Therefore, an early diagnosis is required to adequately guide treatment. Lyme disease is usually diagnosed clinically; However, in unclear cases, Lyme antibodies are used to detect Lyme disease.

Hepatitis C antibodies
Hepatitis C is a chronic liver infection that is acquired through contact with other people's blood or through sexual intercourse. It is related to the neuropathy commonly associated with cryoglobulinemia, a condition in which antibodies precipitate in blood vessels at low temperatures, blocking them and causing inflammation in blood vessels and organs. The skin and kidneys are often affected. The hepatitis C antibody test is the first step in diagnosing the disease. If the hepatitis C antibody screen is positive, the hepatitis C RNA test will confirm hepatitis C infection. Other causes of cryoglobulinemia include other autoimmune diseases, leukemia, multiple myeloma, and others.

Blood and bone marrow tests for cancer and precancerous lesions

blood or urine electrophoresis
This detailed protein scan can identify cancerous or precancerous blood disorders associated with peripheral neuropathy. Some examples are multiple myeloma, Waldenstrom's macroglobulinemia, and monoclonal gammopathy.

Serum-free light chains
This kappa and lambda blood protein test can identify cancer or precancerous blood disorders associated with peripheral neuropathy.

Other tests are done individually.

oral glucose tolerance test
This is the most stringent test to diagnose diabetes and prediabetes. It requires not eating or drinking anything after dinner and taking blood (fasting blood sugar) the next morning before eating or drinking. Patients are given a sugary liquid containing a precise amount of glucose to drink, and then their blood sugar is retested at set times, usually 2 hours later.

Genetic (DNA) sequencing
Genetic testing is done when doctors suspect that the neuropathy appears to be affecting members of the patient's family line. This suspicion is learned in a conversation with the patient and then followed up with tests. The objective is to identify the genetic changes responsible for hereditary neuropathy and thus make a specific diagnosis. An example is Charcot-Marie-Tooth disease, one of the most common inherited neurological disorders, which affects 1 in 2,500 people in the United States. There is degeneration of the nerve due to the lack of special proteins necessary for its functioning. Symptoms include muscle weakness and atrophy, incoordination when walking, a tingling or dull sensation, a high arch, and hammertoes. Treatment is multidisciplinary, but there is no cure.

abdominal fat biopsy
It consists of extracting a small amount of fat under the skin of the abdomen with a needle and local anesthesia. This can detect deposits of the abnormal protein known as amyloid. When this protein accumulates in the nerves, it can cause neuropathy.


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