What lab tests should be ordered for preventative medicine?

Recommended Laboratory Tests for Preventative Medicine

For general preventative medicine, a comprehensive set of laboratory tests should include complete blood count, comprehensive metabolic panel, lipid profile, hemoglobin A1C, and urinalysis as core tests, with additional specialized testing based on age, risk factors, and specific conditions. 1

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
• Lipid profile, including total cholesterol, LDL, HDL, and triglycerides to assess cardiovascular risk 1, 3
• Hemoglobin A1C to screen for diabetes and prediabetes 1
• Urinalysis with albumin-to-creatinine ratio to screen for kidney disease and urinary tract infections 1, 3
• Blood pressure measurement at every visit 1

Age and Risk-Based Screening

Diabetes Screening

• Annual 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

• Fasting lipid profile every 6-12 months 1
• Abdominal ultrasonography once for men aged 65-75 years who have ever smoked 1

HIV and STI Screening

For patients at risk or as part of routine screening:

• HIV testing with fourth- or fifth-generation laboratory-based antigen-antibody assay 3
• Screening for other sexually transmitted infections 3
• Screening for syphilis 3
• Hepatitis screening (Hepatitis B surface antigen, antibody to hepatitis B surface antigen or to hepatitis B core antigen, antibody to hepatitis C virus, total hepatitis A antibody) 3

Special Considerations for Older Adults

• Thyroid-stimulating hormone (TSH) testing, particularly important for women and older adults 1
• Bone densitometry for postmenopausal women and men age ≥50 years 1
• Functional performance assessment for adults ≥65 years 3, 1
• Screening for cognitive impairment in older adults with risk factors 1

Medication-Specific Monitoring

• Vitamin B12 levels for patients on metformin 3, 1
• Serum potassium levels for patients on ACE inhibitors, ARBs, or diuretics 3, 1
• Liver function tests for patients on certain medications that can affect the liver 3
• Medication-specific monitoring based on individual drug profiles 3

Disease-Specific Monitoring

For Patients with Diabetes

• A1C every 3-6 months 3
• Lipid profile annually 3
• Urinary albumin-to-creatinine ratio annually 3
• Serum creatinine and estimated glomerular filtration rate annually 3

For Patients with HIV

• CD4 cell count and percentage 3
• HIV viral load 3
• HIV resistance testing (genotype determination preferred in antiretroviral-naive patients) 3
• Screening for co-infections (tuberculosis, viral hepatitis, etc.) 3

Clinical Pearls and Pitfalls

• Individual patients have stable hematological setpoints that can persist for decades, making personalized reference intervals potentially more valuable than population-based ones 4
• CBC results should be interpreted in context of the patient's previous results when available, as this improves sensitivity and specificity for various conditions 4
• Over-ordering of CBCs without clear clinical indications can lead to unnecessary follow-up testing and increased healthcare costs 5
• Laboratory monitoring frequency should balance the risk of adverse events with the pain, inconvenience, and cost of phlebotomy 3
• For patients on multiple medications requiring monitoring, follow the more frequent schedule for laboratory testing 3

Special Population Considerations

Obesity Management

• Basic laboratory evaluation should include a comprehensive metabolic panel, fasting lipid profile, and thyroid function tests 3
• Screen for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40–70 years with overweight or obesity 3

Cancer Screening and Monitoring

• Disease-specific monitoring protocols should be followed for patients with cancer or at high risk 3
• For multiple myeloma monitoring: CBC, serum chemistry for creatinine, albumin, LDH, calcium, and β-2 microglobulin 3

By implementing these comprehensive laboratory testing recommendations, clinicians can effectively screen for common conditions, monitor existing diseases, and provide appropriate preventative care to their patients.