Recommended Laboratory Tests for Annual Physical Examinations
The most essential laboratory tests for annual physical examinations include complete blood count (CBC), comprehensive metabolic panel (CMP), lipid profile, hemoglobin A1C, and urinalysis with albumin-to-creatinine ratio. 1, 2
Core Laboratory Tests for All Adults
- Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 1, 2
- Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 1, 2
- Lipid profile, including total cholesterol, LDL, HDL, and triglycerides, to assess cardiovascular risk 1, 2
- Hemoglobin A1C to screen for diabetes and prediabetes 1, 3
- Urinalysis with albumin-to-creatinine ratio to screen for kidney disease and urinary tract infections 1, 3
- Blood pressure measurement at every visit 1, 3
Age and Risk-Based Screening
Diabetes Screening
- Annual hemoglobin A1C testing for adults with BMI ≥25 kg/m² with one or more risk factors (first-degree relative with diabetes, high-risk race/ethnicity, history of cardiovascular disease, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, polycystic ovary syndrome, physical inactivity) 1, 3
- Yearly testing for patients with prediabetes (A1C 5.7-6.4%) 1
- Testing beginning at age 35 and repeating every 3 years if normal for all other adults 1
Cardiovascular Screening
- Annual blood pressure check for all patients 1, 3
- Fasting lipid profile every 6-12 months for all patients 1
- Abdominal ultrasonography once for men aged 65-75 years who have ever smoked 1
Special Considerations for Older Adults
- Thyroid-stimulating hormone (TSH) testing for women and older adults 1, 3
- Bone densitometry for postmenopausal women and men age ≥50 years 1
- Functional performance assessment for adults ≥65 years 3
- Screening for cognitive impairment in older adults with risk factors 1, 3
Medication-Specific Monitoring
- Vitamin B12 levels for patients on metformin 1, 3
- Serum potassium levels for patients on ACE inhibitors, ARBs, or diuretics 1, 3
Common Pitfalls and Considerations
- Ordering unnecessary tests can lead to false positives, increased costs, and patient anxiety 4, 5
- Basic metabolic panels (BMP) may be sufficient for patients without specific risk factors, potentially saving costs 5
- Abnormal results on routine panels can predict mortality risk, so follow-up on abnormalities is crucial 6
- Laboratory tests should be interpreted in the context of the patient's clinical presentation and risk factors 7
- Patients with specific conditions may require additional specialized testing beyond standard annual panels 3
Special Population Considerations
Patients with Diabetes
- More frequent monitoring of hemoglobin A1C (typically every 3-6 months) 3
- Annual screening for diabetes complications including nephropathy (urine albumin-to-creatinine ratio), retinopathy (eye exam), and neuropathy (foot exam) 3
Patients with Chronic Kidney Disease
- More frequent monitoring of electrolytes, BUN, and creatinine 3
- Monitoring for anemia and metabolic bone disease 3
Patients on Specific Medications
- Liver function tests for patients on statins or other hepatotoxic medications 3
- Complete blood count for patients on medications that may cause bone marrow suppression 3
Remember that these recommendations represent a general framework, and the specific tests ordered should be guided by the patient's age, sex, risk factors, and current health status. The goal is to detect common conditions early while avoiding unnecessary testing.