Laboratory Testing for Annual Physical Examinations
Yes, order both a CBC and CMP for annual physical examinations in all adults, as these are core screening tests recommended by major medical organizations to detect common conditions and assess organ function. 1, 2
Core Laboratory Tests for All Adults
The following tests should be ordered as part of routine annual screening:
Complete Blood Count (CBC)
- CBC with differential is recommended for all adults to screen for anemia, infection, and blood disorders 1, 2
- CBC components predict cardiovascular disease, metabolic syndrome, and type 2 diabetes risk 3
- Approximately 10-20% of CBC results reveal abnormalities requiring further evaluation 4
Comprehensive Metabolic Panel (CMP)
- CMP is recommended for all adults to assess kidney function (creatinine, eGFR), liver function (AST, ALT, alkaline phosphatase, bilirubin, albumin), and electrolyte balance (sodium, potassium, calcium, bicarbonate) 1, 2
- Serum creatinine measurement with eGFR calculation is specifically recommended for all patients with hypertension to screen for chronic kidney disease 5
- The CMP provides more comprehensive information than a basic metabolic panel (BMP), particularly for detecting liver disease and protein abnormalities 6
Additional Core Tests
- Lipid profile (total cholesterol, LDL, HDL, triglycerides) every 6-12 months 1, 2
- Hemoglobin A1C to screen for diabetes and prediabetes 1, 2
- Urinalysis with albumin-to-creatinine ratio rather than urine dipstick, as it is more sensitive for detecting early kidney disease 5, 1, 2
Risk-Based and Age-Specific Testing
Diabetes Screening
- Begin testing at age 35 and repeat every 3 years if results are normal 1
- Test annually for adults with BMI ≥25 kg/m² plus one or more risk factors: first-degree relative with diabetes, high-risk ethnicity, cardiovascular disease history, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, polycystic ovary syndrome, or physical inactivity 5, 1
- Test yearly for patients with prediabetes (A1C 5.7-6.4%) 1
Kidney Disease Screening
- Annual screening with eGFR and urine albumin-to-creatinine ratio is recommended for patients with diabetes, hypertension, cardiovascular disease, age ≥60 years, family history of kidney disease, previous acute kidney injury, or preeclampsia 5, 7
- For patients with moderate-to-severe CKD, repeat measurements at least annually 5
Additional Age-Based Tests
- Thyroid-stimulating hormone (TSH) particularly for women and older adults 1, 2
- Vitamin B12 levels for patients on metformin 1, 2
- Serum potassium for patients on ACE inhibitors, ARBs, or diuretics 1, 2
Clinical Context Matters
When CMP is Particularly Important
The comprehensive panel becomes especially valuable when:
- Evaluating patients with hypertension to detect end-organ damage and guide medication choices 5
- Screening for chronic kidney disease in at-risk populations, as diabetes and hypertension are strongly associated with CKD across all age groups 8
- Assessing patients with diabetes who require monitoring of kidney function and electrolytes 5
Cost Considerations
While a BMP costs approximately $21 less than a CMP, the additional liver function tests and protein measurements in the CMP provide valuable screening information that justifies the cost for annual comprehensive assessment 6
Common Pitfalls to Avoid
- Do not use urine dipstick alone for kidney disease screening—always order albumin-to-creatinine ratio for greater sensitivity 5
- Do not skip eGFR calculation when ordering creatinine—use the CKD-EPI equation without race variable 7
- Do not forget to repeat abnormal results and consider specialist referral when values indicate significant organ dysfunction 4
- Do not order tests in isolation—blood pressure measurement should accompany all laboratory screening 5, 1