What lab tests are recommended for a general annual routine health screening for a government employee?

Annual Routine Laboratory Screening for Government Employees

For a healthy adult government employee, routine annual laboratory screening should include a comprehensive metabolic panel, complete blood count, lipid profile, hemoglobin A1C, urinalysis with albumin-to-creatinine ratio, and thyroid-stimulating hormone, with specific tests tailored based on age and individual risk factors.

Core Laboratory Tests for All Adults

The following tests form the foundation of annual screening regardless of age:

• Complete Blood Count (CBC) with differential screens for anemia, infection, and blood disorders 1
• Comprehensive Metabolic Panel (CMP) assesses kidney function (creatinine, BUN), liver function (AST, ALT, alkaline phosphatase, bilirubin, albumin), and electrolyte balance (sodium, potassium, chloride, bicarbonate) 2, 1
• Urinalysis with albumin-to-creatinine ratio screens for kidney disease and urinary tract infections 2, 1
• Blood pressure measurement should be performed at every visit 2, 1

Age-Stratified Lipid Screening

The approach to lipid screening depends critically on age and risk factors:

Adults Under Age 40

• No routine lipid screening is recommended for healthy adults under 40 without risk factors 3
• Screen at age 20 if any of the following risk factors are present: diabetes, family history of cardiovascular disease before age 50 in male relatives or age 60 in female relatives, tobacco use, hypertension, or obesity 3
• If screening is performed, obtain a lipid profile at initial evaluation and repeat every 5 years if no risk factors are present 3

Adults Age 40-75

• Lipid testing is strongly recommended for all adults in this age group 3
• Obtain total cholesterol, LDL, HDL, and triglycerides 1
• Repeat every 5 years for those with normal results 3
• Shorter intervals are appropriate for persons with lipid levels close to treatment thresholds 3

Diabetes Screening with Hemoglobin A1C

The timing and frequency of A1C testing varies by risk profile:

Low-Risk Adults

• Begin screening at age 35 and repeat every 3 years if normal 1
• Alternatively, begin at age 45 for those without any risk factors 3
• For adults age 40-70 with BMI ≥25 kg/m², screening is recommended 3

High-Risk Adults

• Annual testing is recommended for adults with BMI ≥25 kg/m² plus 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, or physical inactivity 1
• Yearly testing for patients with prediabetes (A1C 5.7-6.4%) 1

Thyroid Function Testing

• Thyroid-Stimulating Hormone (TSH) is particularly important for women and older adults, as thyroid disorders increase with age 2, 1
• Include TSH in the annual screening panel 2

Age-Specific Additional Tests

Men Age 50 and Older

• Prostate-Specific Antigen (PSA) annually (earlier in high-risk men) 2

Men Age 65-75 Who Have Ever Smoked

• Abdominal ultrasonography once for abdominal aortic aneurysm screening 1

Adults Age 65 and Older

• All core tests listed above remain important 2
• Functional performance assessment 1
• Screening for cognitive impairment in those with risk factors 1

Medication-Specific Monitoring

If the employee is taking certain medications, additional monitoring is required:

• Vitamin B12 levels for patients taking metformin 2, 1
• Serum potassium levels for patients on ACE inhibitors, ARBs, or diuretics 2, 1

Important Technical Considerations

Sample Collection

• Total cholesterol and HDL can be measured on non-fasting samples, making screening more convenient 3
• Fasting samples are needed for accurate triglyceride measurement if lipoprotein analysis is required 3

Result Confirmation

• Abnormal results should be confirmed by a repeated sample on a separate occasion 3
• Use the average of both results for risk assessment and treatment decisions 3

Common Pitfalls to Avoid

• Never rely on a single lipid measurement for diagnosis or treatment decisions 3
• Avoid screening all young adults regardless of risk factors, which leads to unnecessary testing and cost 3
• Do not order a CMP reflexively in pediatric populations without clinical indicators, as this can lead to unnecessary costs; however, for adult government employees, the CMP is part of standard screening 4
• Recognize that "liver function tests" are not all true tests of liver function and abnormalities may not reflect liver disease 5