What is the lab work for a comprehensive medical evaluation?

Laboratory Work for a Comprehensive Medical Evaluation

A comprehensive medical evaluation should include a complete blood count (CBC), comprehensive metabolic panel (including serum calcium, liver function studies, and serum creatinine), lipid profile, urinalysis, and hemoglobin A1C, along with additional tests based on age, risk factors, and presenting conditions.

Core Laboratory Tests

Essential Tests for All Patients

• Complete Blood Count (CBC) with differential 1

  • Evaluates red blood cells, white blood cells, platelets
  • Helps identify anemia, infection, inflammation, bleeding disorders

• Comprehensive Metabolic Panel (CMP) 1

  • Electrolytes (sodium, potassium, chloride, bicarbonate)
  • Kidney function (BUN, creatinine, eGFR)
  • Liver function tests (ALT, AST, alkaline phosphatase, bilirubin)
  • Glucose
  • Calcium
  • Total protein and albumin

• Lipid Profile 1

  • Total cholesterol
  • LDL cholesterol
  • HDL cholesterol
  • Triglycerides

• Urinalysis 1

  • Spot urinary albumin-to-creatinine ratio (to assess kidney function)

Additional Baseline Tests

• Hemoglobin A1C (for diabetes screening/monitoring) 1
• Thyroid-stimulating hormone (TSH) (especially for patients with type 1 diabetes) 1
• Vitamin B12 levels (for patients on metformin) 1
• Serum potassium levels (for patients on ACE inhibitors, ARBs, or diuretics) 1

Age and Risk-Based Testing

Cardiovascular Risk Assessment

• 10-year atherosclerotic cardiovascular disease risk assessment using race and sex-specific Pooled Cohort Equations 1

Specialized Testing Based on Symptoms or Conditions

• For suspected kidney disease: eGFR, urinary albumin-to-creatinine ratio 1
• For suspected liver disease: Liver function tests 1
• For bone health assessment: Calcium, vitamin D, and phosphorus 1

Immunization Status and Infectious Disease Screening

• Vaccination history 1
• Serologies for HIV and hepatitis B and C (as indicated) 1
• Screening for tuberculosis (when indicated)

Additional Tests Based on Clinical Presentation

For Patients with Specific Symptoms

• Coagulation profile (PT/INR, PTT) for bleeding risk assessment 1
• Lactate dehydrogenase (LDH) for tissue damage assessment 1
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) for inflammation assessment 1
• Quantitative immunoglobulin levels when immunodeficiency is suspected 1

For Autoimmune Disease Screening

• Antinuclear antibodies (ANA) and rheumatoid factor when autoimmune disease is suspected 1

Common Pitfalls to Avoid

1. Failing to provide clinical information with laboratory requests - This information helps laboratory staff interpret results appropriately 2

2. Over-testing without clinical indication - Order tests based on patient's specific risk factors and symptoms

3. Ignoring borderline abnormal values - These may be early indicators of disease processes

4. Not considering medication effects on laboratory values - Many medications can alter test results

5. Interpreting laboratory results in isolation - Always interpret results in context of the patient's clinical presentation

Follow-up Testing Intervals

• For patients without chronic conditions: Annual comprehensive evaluation 1
• For patients with diabetes: Every 3-6 months, individualized to the patient 1
• For patients with other chronic conditions: Follow-up intervals should be determined based on condition stability and treatment response

Laboratory testing should be viewed as one component of the comprehensive medical evaluation, which also includes a thorough history, physical examination, and assessment of psychosocial factors and social determinants of health.