What labs should be ordered for a 24-year-old's annual check-up?

Laboratory Testing for a 24-Year-Old Annual Check-Up

For a healthy 24-year-old without specific risk factors, routine laboratory testing is not recommended as part of an annual physical examination, as screening asymptomatic young adults provides no demonstrated benefit. 1

Core Screening Approach

Cardiovascular Risk Assessment

• Blood pressure measurement is the only universally recommended screening test starting at age 18 years, though optimal screening interval is uncertain and annual screening is reasonable 2
• Lipid profile screening does not routinely begin until age 35-40 years for average-risk individuals, though it may be considered starting in the early 20s based on clinical judgment for those with cardiovascular risk factors 2, 3
• Non-fasting lipid panels are acceptable for initial screening if ordered 4

Metabolic Screening

• Diabetes screening (HbA1c, fasting glucose, or oral glucose tolerance test) is recommended starting at age 35 years, or earlier (including at age 24) if BMI ≥25 kg/m² with additional risk factors including: 2, 3
  • First-degree relative with diabetes
  • High-risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
  • History of cardiovascular disease
  • Hypertension (≥140/90 mmHg or on therapy)
  • HDL cholesterol <35 mg/dL or triglycerides >250 mg/dL
  • Physical inactivity
  • Polycystic ovary syndrome
  • History of gestational diabetes (if female)

Sex-Specific Cancer Screening

For females aged 24:

• Cervical cancer screening with Pap test every 3 years starting at age 21 (HPV co-testing is not recommended until age 30) 2
• Clinical breast examination every 3 years for women ages 20-39 2

For males aged 24:

• No routine laboratory cancer screening is recommended at this age 2
• Testicular examination as part of cancer-related checkup every 3 years for ages 20-39 4

Risk-Based Laboratory Testing

When to Order Additional Labs

Complete blood count (CBC) should only be ordered if there are specific clinical indications such as: 5, 6, 1

• Symptoms of anemia (fatigue, pallor, dyspnea)
• Suspected infection
• Unexplained bleeding or bruising
• Known hematologic disorder requiring monitoring

Comprehensive metabolic panel is indicated only when: 7, 3

• Kidney or liver disease is suspected
• Patient is on medications requiring monitoring
• Specific symptoms warrant evaluation

Sexually transmitted infection screening (syphilis, gonorrhea, chlamydia, HIV, hepatitis B and C) should be performed based on sexual history and risk factors including: 3

• Multiple sexual partners or new partners
• Men who have sex with men
• Injection drug use
• History of STIs

Cancer-Related Health Maintenance

• Cancer-related checkup every 3 years for ages 20-39 should include examination for cancers of the thyroid, testicles (males), ovaries (females), lymph nodes, oral cavity, and skin 2, 4
• Health counseling about tobacco use, sun exposure, diet, physical activity, and sexual practices 4

Common Pitfalls to Avoid

• Ordering routine "screening" labs in healthy young adults wastes resources and has no demonstrated benefit in asymptomatic individuals without risk factors 1
• Failing to assess individual risk factors (family history, BMI, lifestyle factors) leads to both over-testing and under-testing 7, 3
• Ordering tests "just because it's an annual exam" is not evidence-based practice for this age group 1

Bottom Line Algorithm

1. Measure blood pressure at every visit 2
2. Calculate BMI and assess for metabolic risk factors 2, 3
3. If BMI ≥25 kg/m² with risk factors: Order HbA1c or fasting glucose 3
4. If cardiovascular risk factors present: Consider lipid profile 2, 3
5. Assess sexual health history: Order STI screening if indicated 3
6. For females: Ensure Pap test every 3 years starting age 21 2
7. No other routine labs are recommended for healthy 24-year-olds 1