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Petition for Help

In Bulgaria we have a laboratory to measure the levels of fat-soluble vitamins!
What to do?
Thank you very much for your question.
• Plasma levels of fat soluble vitamins A D and E, total cholesterol, vitamin E: cholesterol ratio and prothrombin time should be checked as part of an annual assessment. Ideally this should be carried out at a time of clinical stability in all CF individuals.

• Pancreatic sufficient patients need to be monitored annually to ensure continuing adequacy of plasma vitamin levels or the need for supplementation

• Plasma levels of Vitamins A and E can be measured by the reverse phase chromatography method using a gel tube. The tube should not contain EDTA , oxalate or citrate, should be protected from sunlight and should be taken after an overnight fast.

• Plasma levels of 25-hydroxy Vitamin D sample should be sent in a plain tube immediately to your local laboratory and can be measured by the radio immune assay method (RAI method)
• The PIKVA II test for vitamin K measurement should be considered, although not routinely available.
• All fat soluble vitamin levels should be interpreted based on current supplementation dose, adherence to supplementation and pancreatic enzymes, clinical status, other serum levels (eg Zn and RBP for vitamin A interpretation), season of measurement (vitamin D) and renal (vitamin D) or liver disease (vitamins A ,D and K). In the case of Vitamin D, levels should be interpreted using your local laboratory reference range.
• Supplementation is recommended if vitamin levels are low.
• Monitor vitamin levels and review the supplementation regimen 3-6 monthly until levels normalise, then revert back to annual monitoring.

I hope you find this information helpful

Best wishes
Dee Shimmin

Further information can be obtained from:
The Leeds Method of Management. April, 2008. Vitamins [online]. Leeds Regional Adult and Paediatric Cystic Fibrosis Units, St James's University Hospital, Leeds, UK. Available from

The answer is edited by: Dee Shimmin