What standard blood work is recommended for a 69-year-old female's annual exam?

Standard Blood Work for a 69-Year-Old Female Annual Exam

For a 69-year-old woman's annual exam, order a complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel, hemoglobin A1c, and thyroid-stimulating hormone (TSH), as these tests provide essential screening for cardiovascular disease, diabetes, anemia, renal function, and metabolic disorders that become increasingly prevalent in this age group.

Core Laboratory Tests

Complete Blood Count (CBC)

• The CBC is one of the most frequently ordered and valuable laboratory tests for assessing overall health status in older adults 1, 2.
• Components include red blood cell count, hemoglobin, hematocrit, white blood cell count with differential, and platelet count 3.
• The CBC provides unique cardiovascular risk information beyond traditional risk factors, with white blood cell count, neutrophil count, and hemoglobin levels strongly associated with cardiovascular disease and all-cause mortality 4.
• Hemoglobin and red cell indices help detect anemia, which is common in older women and impacts quality of life 2, 3.

Comprehensive Metabolic Panel (CMP)

• Order a CMP to assess kidney function (creatinine, BUN), electrolytes (sodium, potassium, chloride, bicarbonate), liver function (AST, ALT, alkaline phosphatase, bilirubin), and glucose 5.
• Renal function assessment is critical in this age group for medication dosing and detecting chronic kidney disease 2.
• Baseline glucose screening identifies undiagnosed diabetes or prediabetes 5.

Lipid Panel

• A lipid panel (total cholesterol, LDL, HDL, triglycerides) remains important for cardiovascular risk assessment at age 69 5, 4.
• Traditional risk factors like lipids account for significant cardiovascular disease risk, though the CBC provides additional independent prognostic information 4.

Hemoglobin A1c

• Screen for diabetes with hemoglobin A1c annually, as diabetes prevalence increases with age and impacts cardiovascular outcomes 5.
• HbA1c provides a 3-month average of glucose control and helps identify prediabetes 5.

Thyroid Function

• Check TSH to screen for thyroid dysfunction, which is more common in older women and can affect metabolism, cardiovascular function, and quality of life 2.

Cancer Screening Considerations

Breast Cancer Screening

• At age 69, continue biennial mammography screening 6.
• The American Cancer Society recommends women aged 55 and older transition to biennial screening or continue annual screening based on individual preference 6.
• Continue screening as long as overall health is good and life expectancy exceeds 10 years 6.
• Clinical breast examination is no longer routinely recommended by most organizations 6.

Cervical Cancer Screening

• Pap testing can be discontinued after age 65 if there have been consistently normal results on previous tests 6.
• At age 69, if the patient has had adequate prior screening with normal results, no further Pap tests are needed 6.
• The American Geriatrics Society recommends Pap tests every three years until age 70, but discontinuation is appropriate with prior normal screening 6.

Colorectal Cancer Screening

• Continue colorectal cancer screening with annual fecal occult blood testing (FOBT) and/or colonoscopy every 10 years (if last colonoscopy was normal) 6.
• Alternative options include flexible sigmoidoscopy every 5 years or double-contrast barium enema every 5-10 years 6.
• Most organizations recommend screening beginning at age 50 and continuing through at least age 75 6.

Important Caveats

Individualization Based on Life Expectancy

• The decision to continue cancer screening should be based on overall health status and estimated life expectancy of at least 10 years, not age alone 6.
• Women with significant comorbidities or functional limitations may not benefit from continued screening 6.

Risk Factor Modifications

• If the patient has additional risk factors (family history, prior abnormal results, chronic diseases), screening intervals and test selection may need adjustment 6.
• Women with dense breasts may benefit from supplemental ultrasound screening in addition to mammography 6.

Avoid Over-Testing

• Do not routinely screen for endometrial cancer in asymptomatic average-risk women, as it is neither cost-effective nor warranted 6.
• Focus laboratory testing on conditions that impact morbidity, mortality, and quality of life rather than ordering comprehensive panels without clinical indication 2, 4.