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Laboratory evaluation may be considered for: Patients with pre-existing anemia or history of hematologic disorders Individuals with chronic kidney disease, as this population has increased risk of anemia Those experiencing persistent gastrointestinal symptoms affecting nutritional intake Patients with inadequate dietary intake or suspected nutritional deficiencies Older adults or those with multiple comorbidities Patients taking metformin long-term, as the American Diabetes Association notes it can cause vitamin B12 deficiency Potential monitoring parameters may include complete blood count (CBC) with differential, iron studies (serum iron, ferritin, total iron-binding capacity), vitamin B12 levels, and folate levels when clinically indicated

These increases appear early in treatment and remain relatively stable, and have not been associated with increased cardiovascular events in trials conducted to date