Recommended Blood Work for a General Medical Evaluation
For a comprehensive general medical evaluation, I recommend a complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid function tests (TSH and free T4), lipid panel, and hemoglobin A1c as the core laboratory tests. These tests provide essential information about overall health status and can identify common conditions affecting morbidity and mortality.
Core Laboratory Tests
1. Complete Blood Count (CBC)
- Evaluates blood cell components: red blood cells, white blood cells, and platelets
- Helps identify anemia, infections, inflammation, and hematologic disorders
- Includes hemoglobin, hematocrit, white blood cell count with differential, and platelet count
- Neutrophil-to-lymphocyte ratio (NLR) can predict cardiovascular disease risk
2. Comprehensive Metabolic Panel (CMP)
- Liver Function Tests:
- Alanine aminotransferase (ALT)
- Aspartate aminotransferase (AST)
- Alkaline phosphatase (ALP)
- Bilirubin (total and direct)
- Albumin
- Total protein
- Kidney Function Tests:
- Blood urea nitrogen (BUN)
- Creatinine
- Estimated glomerular filtration rate (eGFR)
- Electrolytes:
- Sodium
- Potassium
- Chloride
- Bicarbonate
- Other:
- Glucose
- Calcium
3. Thyroid Function Tests
- Thyroid stimulating hormone (TSH)
- Free thyroxine (Free T4)
- Consider thyroid antibodies (TPO and TGA) if clinically indicated
4. Lipid Panel
- Total cholesterol
- Low-density lipoprotein (LDL)
- High-density lipoprotein (HDL)
- Triglycerides
5. Hemoglobin A1c
- Evaluates average blood glucose over previous 2-3 months
- Screens for diabetes and prediabetes
Additional Tests Based on Risk Factors
Cardiovascular Risk Assessment
- High-sensitivity C-reactive protein (hs-CRP)
- Consider natriuretic peptides (BNP or NT-proBNP) if heart failure is suspected 1
Iron Status (if anemia is suspected)
- Ferritin
- Iron
- Total iron binding capacity (TIBC)
- Transferrin saturation
Vitamin Levels
- Vitamin D (25-hydroxyvitamin D)
- Vitamin B12 and folate (if macrocytic anemia or neurological symptoms present)
Inflammatory Markers
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
Special Considerations
Age-Specific Considerations
- Older Adults: Consider more frequent monitoring of renal function, thyroid function, and complete blood count
- Women of Childbearing Age: Consider adding ferritin to assess iron stores
Disease-Specific Monitoring
- Liver Disease: More comprehensive liver function testing may be warranted 1
- Heart Failure: Consider natriuretic peptides (BNP or NT-proBNP) 1
- Diabetes: More frequent monitoring of HbA1c and renal function
- Immunocompromised Patients: More comprehensive infectious disease screening
Interpretation Pitfalls
- Isolated abnormal values should be interpreted in clinical context and may require repeat testing
- Liver function tests should be interpreted as a panel rather than in isolation 1
- Abnormal thyroid function tests should be confirmed before initiating treatment 2
- Medications can affect laboratory values (e.g., statins can elevate liver enzymes)
Follow-up Recommendations
- Abnormal liver blood tests should be interpreted after review of previous results, past medical history, and current medical condition 1
- For abnormal thyroid function, repeat testing within 3 months for subclinical disease 2
- Consider more specialized testing if initial screening tests are abnormal
This approach provides a systematic evaluation of major organ systems and metabolic processes, allowing for early detection of common conditions that affect morbidity and mortality, while avoiding unnecessary testing.