Laboratory Evaluation for Night Sweats in Young Women
For young women presenting with night sweats, initial laboratory evaluation should include a complete blood count with differential, thyroid-stimulating hormone level, HIV testing, and tuberculosis testing as the core diagnostic workup. 1, 2
Initial Laboratory Assessment
- Complete blood count (CBC) with differential to evaluate for infections, lymphoma, and other hematologic conditions 1, 2
- Thyroid-stimulating hormone (TSH) to rule out hyperthyroidism 1, 2
- HIV testing, especially if other risk factors are present 1, 2
- Tuberculosis testing (PPD or interferon-gamma release assay) 1, 2
- Erythrocyte sedimentation rate (ESR) to screen for inflammatory conditions 1, 2
- C-reactive protein (CRP) level to assess for inflammation 2
- Chest radiography to evaluate for pulmonary conditions including tuberculosis and malignancy 1, 2
Additional Testing Based on Clinical Suspicion
For suspected hematologic disorders:
- Serum immunoglobulin levels, particularly if Waldenström's macroglobulinemia is suspected 3
- Bone marrow biopsy if CBC abnormalities suggest a hematologic malignancy 1
For suspected endocrine disorders:
- Complete metabolic panel to assess liver and kidney function 3
- Serum iron studies if hemochromatosis is suspected (particularly if family history is positive) 4
- Fasting blood glucose to rule out hypoglycemia 1
For suspected infections:
- Hepatitis B and C screening if risk factors present 3
- Specific testing for infectious causes based on geographic and exposure history 3
Clinical Context Considerations
- Night sweats are a common symptom that may not indicate serious pathology in most young women 5, 2
- Night sweats are listed as a clinical indication for initiating therapy in conditions like Waldenström's macroglobulinemia, suggesting their importance as a potential symptom of serious disease 3
- Night sweats combined with other B symptoms (fever, weight loss) increase suspicion for lymphoma, tuberculosis, or other serious conditions 3
Common Pitfalls to Avoid
- Failing to consider non-life-threatening but common causes such as gastroesophageal reflux disease, mood disorders, obesity, or medication side effects 1, 2
- Ordering extensive testing before completing basic laboratory evaluation 2
- Not recognizing that normal laboratory results in a patient with isolated night sweats is reassuring and typically does not indicate increased mortality risk 2
- Overlooking medication-related causes, including antihypertensives and antidepressants 1
If initial laboratory evaluation is unrevealing and symptoms persist, consider selective advanced testing such as computed tomography of the chest/abdomen or polysomnography to evaluate for obstructive sleep apnea 2.