Fit-to-Work Laboratory Assessment
For a standard fit-to-work assessment in healthy individuals, a basic laboratory panel should include: complete blood count (CBC), comprehensive metabolic panel (including electrolytes, renal function, liver function, and glucose), lipid profile, and urinalysis. This baseline approach identifies common medical conditions that could impact workplace safety and performance.
Core Laboratory Tests
The essential laboratory workup for fit-to-work evaluation should include 1:
- Complete blood count (CBC) - screens for anemia, infection, and hematologic disorders 1
- Comprehensive metabolic panel - assesses electrolytes (sodium, potassium, chloride, calcium, magnesium), renal function (BUN, creatinine), liver function (transaminases, alkaline phosphatase, bilirubin, albumin), and glucose metabolism 1
- Fasting blood glucose or glycohemoglobin (HbA1c) - screens for diabetes 1
- Lipid profile - evaluates cardiovascular risk 1
- Urinalysis - detects renal disease, diabetes, and urinary tract abnormalities 1
Additional Considerations Based on Risk Factors
Thyroid function testing (TSH) should be included in the initial evaluation, as thyroid disorders commonly affect work capacity and energy levels 1. This is particularly important given the high prevalence of undiagnosed thyroid disease in the general population.
For patients over 40 years or those with cardiovascular risk factors, the U.S. Preventive Services Task Force recommends screening for abnormal blood glucose as part of cardiovascular risk assessment 1.
Occupation-Specific Testing
The laboratory panel may need expansion based on specific occupational exposures or requirements:
- Hepatitis B testing (HBsAg and HBcAb) for healthcare workers or those with potential blood exposure 1
- Hepatitis C testing for high-risk occupations 1
- Liver function tests are already included in the comprehensive metabolic panel but warrant particular attention for workers with chemical exposures 1
Clinical Context Matters
While the evidence provided focuses primarily on disease-specific evaluations (heart failure, cancer, etc.), these are not applicable to routine fit-to-work assessments in healthy individuals. The comprehensive metabolic panel approach provides cost-effective screening that identifies the most common conditions affecting workplace fitness 1.
Important caveat: The comprehensive metabolic panel is more cost-effective than ordering individual tests when multiple parameters need assessment 2, 3. A basic metabolic panel (BMP) alone may miss important liver function abnormalities that could impact work capacity 3.
Practical Implementation
Order the following as a single panel 1:
- CBC with differential
- Comprehensive metabolic panel (not just basic metabolic panel)
- Lipid panel (fasting preferred)
- TSH
- Urinalysis
- HbA1c (if diabetes screening indicated)
This approach provides comprehensive screening while avoiding unnecessary testing and associated costs 3.