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After treatment and remission

Follow-up blood tests

Follow-up is not only about the blood count. Your doctor may also track how your organs are working, your iron stores, hormones and markers of infection. This topic explains why these tests are needed.

Last updated: ~2 min read
A translucent glowing liver and two kidneys side by side in soft light.
Figure 1.Biochemistry tracks the recovery of the liver and kidneys.

01Short answer

After treatment, biochemistry tests are taken alongside the blood count: liver enzymes and bilirubin, kidney values (creatinine), electrolytes and glucose. After many transfusions, ferritin (iron stores) may be checked. After some treatments, thyroid hormones, lipids or vitamin D are monitored. After a transplant, immunoglobulins and virus tests are added. Your doctor decides which tests are needed and when, based on the treatment you received. Results are always compared with the laboratory’s ranges and with earlier tests.

02Simple explanation

Blood tests tell you about more than the bone marrow — they also show how organs are doing.

Liver and kidney values reflect the effects of medicines.

Ferritin shows whether iron has built up after many transfusions.

Sometimes hormones and vitamins are checked too.

You can ask your doctor why each test is done.

03Scientific explanation

Biochemistry: according to MedlinePlus, a comprehensive metabolic panel includes glucose, electrolytes and kidney and liver values.

Ferritin: according to MedlinePlus, it reflects the body’s iron stores; it rises after many transfusions but also with inflammation.

Thyroid: COG guidelines advise regular TSH and T4 checks after radiation to the head, neck or whole body.

Personal plan: COG guidelines choose late-effect tests according to the treatment received (drugs, doses, radiation).

04What happens in the body?

Liver and kidneys

Chemotherapy, antibiotics and antifungal medicines can affect the liver and kidneys. ALT, AST, bilirubin and creatinine show their recovery. After treatment they usually return to normal gradually.

Electrolytes and glucose

Potassium, sodium, magnesium and glucose can change with some medicines, especially steroids and post-transplant drugs. Your doctor checks them as needed.

Iron and ferritin

If you had many red cell transfusions, iron can build up in the body. Ferritin helps assess this. A high ferritin does not always mean iron overload — your doctor interprets it together with other information.

Amber iron droplets inside cells next to red blood cells.
Figure 3.Ferritin shows the body’s iron stores.

Hormones, lipids and vitamins

Depending on your treatment, your doctor may check thyroid hormones, cholesterol, vitamin D or sex hormones. This is to spot late effects in time.

Filled blood sample tubes next to blood-draw equipment
Figure 2.Different tests need different tubes.

After a transplant

Immunoglobulins, virus tests (such as CMV), drug levels and sometimes a chimerism test are added. The transplant centre sets the schedule for these tests.

05From test to explanation

Each test has its own purpose.

The list — Your doctor chooses the tests.1The listYour doctor chooses the tests.
Sample taken — Several tubes.2Sample takenSeveral tubes.
Measurement — Organ values.3MeasurementOrgan values.
Comparison — Against earlier results.4ComparisonAgainst earlier results.
Watching the organsChanges are seen early.
The trendRecovery shows in the numbers.
SafetyMedicines are adjusted in time.

06Common tests (simplified)

TestWhat it showsWhy at follow-up
ALT, AST, bilirubinLiver functionMedicine effects, recovery
CreatinineKidney functionMedicine effects
ElectrolytesSalt and water balanceSteroids and other medicines
FerritinIron storesAfter many transfusions
TSH, T4ThyroidAfter some treatments
Lipids, glucoseMetabolismHeart and vessel risks

* The list is not the same for everyone. Your doctor chooses tests to suit your treatment.

07Key terms

Biochemistry
Values showing organ function and metabolism.
ALT / AST
Liver enzymes.
Creatinine
A measure of kidney function.
Ferritin
A protein that reflects iron stores.
TSH
The hormone that controls the thyroid.
Electrolytes
Potassium, sodium, magnesium and others.

08Key points

  • Several kinds of test are used at follow-up.
  • Liver and kidney values are tracked.
  • Ferritin matters after transfusions.
  • Hormones are checked depending on treatment.
  • Tell your doctor about all medicines.
  • Interpret results only with your doctor.

09Frequently asked questions

My liver enzymes are raised. Is that dangerous?

This is common after treatment and usually settles. Your doctor will assess the cause and the trend.

My ferritin is very high. What should I do?

Do not change your food or medicines yourself. Your doctor may arrange more tests and treatment if needed.

Do I need to fast?

For some tests (glucose, lipids), yes. Check with your doctor or the laboratory.

Why are hormones checked?

Some treatments can affect glands later on; finding this early makes treatment easier.

Can vitamins change results?

Yes — biotin, for example, affects some hormone tests. Tell your doctor.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. My liver enzymes are raised. Is that dangerous?

  2. My ferritin is very high. What should I do?

  3. Do I need to fast?

  4. Why are hormones checked?

  5. Can vitamins change results?

My questions

12Sources

  1. MedlinePlus (U.S. National Library of Medicine). Complete Blood Count (CBC)
  2. MedlinePlus (U.S. National Library of Medicine). Comprehensive Metabolic Panel (CMP)
  3. MedlinePlus (U.S. National Library of Medicine). Liver Function Tests
  4. MedlinePlus (U.S. National Library of Medicine). Ferritin Blood Test
  5. MedlinePlus (U.S. National Library of Medicine). Thyroid Tests
  6. NHS. Blood tests
  7. American Cancer Society. Living as an Acute Myeloid Leukemia (AML) Survivor
  8. Blood, 2022. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN
  9. Cancer Research UK. Coping emotionally with cancer
  10. Cancer.Net (ASCO). ASCO Cancer Treatment and Survivorship Care Plans
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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