In this article, I’ll address a real mainstay of modern medicine: laboratory tests that require drawing blood.
This is sometimes referred to as “checking labs,” “doing bloodwork,” or even “checking blood.”
Most older adults have been through this. For instance, it’s pretty much impossible to be hospitalized without having bloodwork done, and it’s part of most emergency room care. Such testing is also often done as part of an annual exam, or “complete physical.”
Last but not least, blood testing is usually — although not always — very helpful when it comes to evaluating many common complaints that affect aging adults.
Fatigued and experiencing low energy? We should perhaps check for anemia and thyroid problems, among other things.
Confused and delirious? Bloodwork can help us check on an older person’s electrolytes (they can be thrown off by a medication side-effect, as well as by other causes). Blood tests can also provide us with information related to infection, kidney function, and much more.
Like much of medical care, blood testing is probably overused. But often, it’s an appropriate and an important part of evaluating an older person’s health care concerns. So as a geriatrician, I routinely order or recommend blood tests for older adults.
Historically, laboratory results were reviewed by the doctors and were only minimally discussed with patients and families. But today, it’s becoming more common for patients to ask questions about their results, and otherwise become more knowledgeable about this aspect of their health.
In fact, one of my top recommendations to older adults and family caregivers is to always request a copy of your laboratory results. (And then, keep it in your personal health record!)
This way, if you ever have questions about your health, or need to see a different doctor, you’ll be able to quickly access this useful information about yourself.
In this article, I’m going to list and briefly explain the blood tests that are most commonly used, for the primary medical care of older adults.
Specifically, I’ll cover four “panels” which are commonly ordered, and then I’ll list six more blood tests that I find especially useful.
In other words, we’re going to cover my top ten blood tests for the healthcare of aging adults.
I’ll finish with some practical tips for you to keep in mind, when it comes to blood tests.
4 common “panels” in laboratory blood testing
1. Complete Blood Count (CBC)
What it measures: A CBC is a collection of tests related to the cells in your blood. It usually includes the following results:
- White blood cell count (WBCs): the number of white blood cells per microliter of blood
- Red blood cell count (RBCs): the number of red blood cells per microliter of blood
- Hemoglobin (Hgb): how many grams of this oxygen-carrying protein per deciliter of blood
- Hematocrit (Hct): the fraction of blood that is made up of red blood cells
- Mean corpuscular volume (MCV): the average size of red blood cells
- Platelet count (Plts): how many platelets (a smaller cell involved in clotting blood) per microliter of blood
The CBC can also be ordered “with differential.” This means that the white blood cells are classified into their subtypes. For more information on the CBC test, see Medline: CBC blood test. For details on the white blood cell count differential, and what the results might signify, see Medline: Blood differential test.
What the CBC is often used for:
- Anemia may be diagnosed if the red blood cell count, hemoglobin, and hematocrit are lower than normal.
- I explain anemia in more depth here: Anemia in the Older Adult: 10 Common Causes & What to Ask.
- The white blood cell count usually goes up if a person is fighting an infection. Some medications, such as corticosteroids, can also cause an increase in the white blood cell count.
- If several types of blood cells (i.e. red blood cells, white blood cells, and platelets) are low, this can be a sign of a problem with the bone marrow.
- Occasionally an older person’s platelet count may be lower than normal (or even higher than normal). This usually requires further evaluation.
2. Basic metabolic panel (basic electrolyte panel)
What it measures: Although it’s possible to request a measurement of a single electrolyte, it’s far more common for electrolytes to be ordered as part of a panel of seven or eight measurements. This is often referred to as a “chem-7,” and usually includes:
- Sodium
- Potassium
- Chloride
- Carbon dioxide (CO2) (sometimes referred to as “bicarbonate,” as this is the chemical form of carbon dioxide which is more common in the bloodstream)
- Blood urea nitrogen (BUN)
- Creatinine (often accompanied by an estimated “glomerular filtration rate,” or “eGFR”result)
- Glucose
What the basic metabolic panel is often used for:
- Medication side-effects can cause electrolytes such as sodium or potassium to be either too high or too low.
- These electrolytes are often monitored when people take certain types of medications, such as certain blood pressure medications, or diuretics.
- Carbon dioxide levels reflect the acidity of the blood.
- This can be affected by kidney function and by lung function. Severe infection can also change acid levels in the blood.
- Creatinine and BUN levels are most commonly used to monitor kidney function. Both of these measurements can go up if kidney function is temporarily impaired (e.g. by dehydration or a medication side-effect) or chronically impaired.
- It is common for older adults to have at least mild decreases in kidney function.
- Many medications must be dosed differently, if a person has decreased kidney function.
- Laboratories now routinely use the patient’s age and creatinine level to calculate an “estimated glomerular filtration rate,” which represents the filtering power of the kidneys. This is considered a better measure of kidney function than simply relying on creatinine and BUN levels.
- Glucose levels represent the amount of sugar in the blood.
- If they are higher than normal, this could be due to undiagnosed diabetes or inadequately controlled diabetes.
- If the glucose levels are on the low side, this is called hypoglycemia. It is often caused by diabetes medications, and may indicate a need to reduce the dosage of these drugs.
For more details on these tests, see Medline: Basic Metabolic Panel. From this page, you can find links to additional pages which explain each of the above electrolytes and metabolic components in detail, including common causes of the result being abnormally high or low.
3. Comprehensive metabolic panel
What it measures: This panel includes the items above in the basic metabolic panel, and then usually includes an additional seven items. For this reason, it’s sometimes referred to as a “chem-14” panel. Beyond the seven tests included the basic panel (see above), the comprehensive panel also adds:
- Calcium
- Total protein
- Albumin
- Bilirubin (total)
- Alkaline phosphatase
- AST (aspartate aminotransferase)
- ALT (alanine aminotransferase)
What the comprehensive metabolic panel is often used for:
- Calcium levels are usually regulated by the kidneys and by certain hormones.
- Blood calcium levels are not usually a good way to assess calcium intake or total calcium stores in the bones and body.
- High or low blood calcium levels can cause symptoms, including cognitive dysfunction, and usually indicate an underlying health problem. They can also be caused by certain types of medication.
- Albumin is one of the key proteins in the bloodstream. It is synthesized by the liver.
- Low albumin levels may indicate a problem with the liver or a problem maintaining albumin in the bloodstream.
- Malnutrition may cause low albumin levels.
- AST and ALT are enzymes contained in liver cells.
- An elevation in these enzymes often indicates a problem affecting the liver. This can be caused by medications or by a variety of other health conditions.
- Bilirubin is produced by the liver, and usually drains down the bile ducts and into the small intestine. Some bilirubin is also related to the breakdown of red blood cells.
- An increase in bilirubin can be caused by gallstones or another issue blocking the bile ducts.
- Alkaline phosphatase is found throughout the body, but especially in bile ducts and also in bone.
- Higher levels are often caused by either a blockage in the liver or by a problem affecting bone metabolism.
For more details on these tests, and the possible causes of abnormal results, see Medline: Comprehensive Metabolic Panel.
4. Lipid (cholesterol) panel
What it measures: These tests measure the different types of cholesterol and related fats in the bloodstream. The panel usually includes:
- Total cholesterol
- High-density lipoprotein (HDL) cholesterol, sometimes known as “good” cholesterol
- Triglycerides
- Low-density lipoprotein (LDL) cholesterol, sometimes known as “bad” cholesterol
- LDL results are usually calculated, based on the other three results
People are often asked to fast before having their cholesterol checked. This is because triglycerides can increase after eating, and this can cause a falsely low LDL to be calculated. However, research suggests that in most cases, it’s not necessary for people to fast; it’s inconvenient and only makes a small difference in test results.
What the lipid panel is often used for:
- These tests are usually used to evaluate cardiovascular risk in older adults.
- Higher than normal total or LDL cholesterol levels are sometimes treated with a medication, such as a statin. They can also be reduced by dietary changes (see Your Guide to Lowering Cholesterol with Therapeutic Lifestyle Changes, from the NIH).
- For more on these tests, see Medline: Cholesterol testing and results.
6 more blood tests that I order often
Here are six other types of tests that I often order on my older patients:
1. Tests related to thyroid function
What these measure: These tests can be used to screen for thyroid disorders, or to help calibrate the dosage of thyroid replacement medications. The most commonly used tests are:
In more complicated situations, other tests related to thyroid function may also be ordered.
What these tests are often used for:
- Thyroid problems are common in older adults (especially older women), and are associated with symptoms such as fatigue and cognitive difficulties.
- If an older person is having symptoms that could be related to a thyroid problem, the first step is to check the TSH level.
- TSH usually reflects the body’s determination of whether the available thyroid hormone is sufficient or not.
- If the thyroid gland is not making enough thyroid hormone, TSH should be higher than normal.
- Free T4 is often used to confirm a thyroid hormone problem, if the TSH is abnormal.
For more information about thyroid problems in older adults, see HealthinAging.org: Thyroid Problems. You can also read a more in-depth scholarly article here: Approach to and Treatment of Thyroid Disorders in the Elderly.
2. Tests related to vitamin B12 levels
What these measure: These measure the serum levels of vitamin B12 and provide information as to whether the level is adequate for the body’s needs. The two tests involved are:
Depending on the situation, if an older adult is found to have low vitamin B12 levels, additional testing may be pursued, to determine the underlying cause of this vitamin deficiency.
What these tests are often used for:
- Vitamin B12 deficiency is quite common in older adults, and can be related to common problems such as fatigue, memory problems, and walking difficulties.
- Methylmalonic acid levels in the body are related to vitamin B12 levels, and can help confirm a vitamin B12 deficiency.
- It is especially important to check this, if an older person has vitamin B12 levels that are on the low side of normal.
- Low vitamin B12 levels are associated with higher-than-normal methylmalonic acid levels
- For more information, see: How to Avoid Harm from Vitamin B12 Deficiency.
3. Glycated hemoglobin (Hemoglobin A1C)
What it measures: Glycated hemoglobin is formed in the body when blood glucose (blood sugar) attaches to the hemoglobin in red blood cells. It is normal for glucose to do this, but if you have more glucose in the blood than normal, your percentage of glycated hemoglobin will be higher than normal. The higher one’s average blood sugar level, the greater percentage of glycated hemoglobin one will have. A result of 6.5% or above is suggestive of diabetes. For more information:
What this test is usually used for:
- This test is most often ordered to monitor the blood sugar control of people with diabetes.
- Whereas a blood glucose level (which can be checked by fingerstick or as part of a basic metabolic panel) reports the blood glucose level at a specific moment in time, a hemoglobin A1C reflects how high a person’s blood sugar has been, on average, over the prior three months.
- A hemoglobin A1C test can also be used as part of an evaluation for possible diabetes or pre-diabetes.
- Older adults should work with their doctors to determine what A1C goal is right for them. It is often appropriate to aim for a slightly higher goal in older adults than in younger adults. For more on this, see HealthinAging.org: Diabetes Care & Treatment.
4. Prothrombin time (PT) and International Normalized Ratio (INR)
What it measures: These two tests are used as a measure of how quickly a person’s blood clots. People taking the blood-thinner warfarin (brand name Coumadin) must have this regularly monitored. For more information:
What this test is usually used for:
- The INR is calculated by the laboratory, based on the prothrombin time. In people taking warfarin, the usual goal is for the INR to be between 2.0 and 3.0.
- The most common reason older adults take warfarin is to prevent strokes related to atrial fibrillation.
- Warfarin may also be prescribed after a person has experienced a blood clot in the legs, lungs, or elsewhere.
- The prothrombin time is also sometimes checked if there are concerns about unexplained bleeding, severe infection, or the ability of the liver to synthesize clotting factors.
5. Brain natriuretic peptide (BNP) test
What it measures: Despite the name, BNP levels are mainly checked because they relate to heart function (not brain function!). BNP levels go up when a person’s heart cannot pump blood as effectively as it should, a problem known as “heart failure.” For more information on this test:
A related, but less commonly used, test is the “N-terminal pro-B-type natriuretic peptide” (NT-proBNP) test.
What this test is used for:
- Checking a BNP level is mainly used to evaluate for new or worsening heart failure. This is a common chronic condition among older adults, which can occasionally get worse.
- The BNP test can be especially useful in evaluating a person who is complaining of shortness of breath.
- Shortness of breath can be caused by several different problems, including pneumonia, chronic obstructive pulmonary disease, pulmonary edema, angina, and much more.
- A low BNP level means that at that moment, the shortness of breath is unlikely to be due to heart failure.
- Checking BNP levels over time is also sometimes used to monitor a person’s heart failure and response to treatment.
- For more about heart failure, see MayoClinic.org: Heart failure tests and diagnosis and also HealthinAging.org: Heart failure.
6. Ferritin
What it measures: The body’s serum ferritin level is related to iron stores in the body. For more about this test:
Depending on the situation, if an older person’s iron levels need further evaluation, additional tests can be ordered.
What this test is used for:
- Ferritin levels are most commonly used as part of an evaluation for anemia (low red blood cell count). A low ferritin level is suggestive of iron-deficiency, which is a common cause of anemia.
- Studies estimate that only a third of anemias in older adults are due to deficiencies in iron or other essential elements.
- It’s important to confirm iron deficiency by checking ferritin or other tests, before relying on iron to treat an older person’s anemia.
- Ferritin levels are also influenced by inflammation, which tends to make ferritin levels rise.
- If the ferritin levels are borderline, or if there are other reasons to be concerned about an older person’s ability to manage iron, additional blood tests related to iron may be ordered.
- For more on evaluating and treating anemia in older adults, see Anemia in the Older Adult: 10 Common Causes & What to Ask.
Obviously, there are many more tests that can be ordered as part of the medical care of older adults. But the tests I cover above are, by far, the ones I order the most often.
Tips to help you benefit from your blood tests and results
Here are my top tips:
1. Be sure you understand why a given test is being ordered. Is it meant to help evaluate a symptom? Monitor a chronic condition? Assess whether a treatment is working?
You will understand your own health issues better, if you ask questions about the purpose of the blood tests your doctors are proposing.
In general, blood tests should only be ordered for a reason, such as to evaluate a concerning symptom, to monitor a chronic disease, or to check for certain types of medication side-effect.
Keep in mind that it’s only occasionally appropriate to order blood tests for “screening.” A screening test means a person doesn’t have any symptoms. Such screening blood tests are only recommended for a handful of conditions.
For more on preventive health care and screening tests that may be appropriate for older adults, see 26 Recommended Preventive Health Services for Older Adults.
2. Ask your doctor to review the results and explain what they mean for your health. Try to look at the report with your doctor. It’s especially important to ask about any result that is flagged as abnormal by the laboratory system.
For instance, I have found that many older adults are unaware of the fact that they have mild or moderate kidney dysfunction, even though this has been evident in prior laboratory tests. This happens when people do not review reports and ask enough questions.
Wondering why the doctor wouldn’t tell an older person that the kidney function is abnormal?
Well, if it’s been going on for a while, the doctor might think the older person already knows about this issue. Or perhaps the doctor mentioned it before, but the older person didn’t quite hear it. It’s also not uncommon for doctors to just not get around to mentioning a mild abnormality that is pretty common in older people, such as mild anemia or mild kidney dysfunction.
3. Ask your doctor to explain how your results compare with your prior results. Laboratory reports will always provide a “normal” reference range. But what’s usually more useful is to see how a given result compares to your previous results.
For instance, if an older person’s complete blood count (CBC) shows signs of anemia, it’s very important to look at prior CBC results. This helps us determine what the “trajectory” of the blood count is. A blood count that is drifting down — or worse yet, dropping fairly suddenly — is much more concerning than one that has been lower-than-normal, but stable for the past year. Ditto test results suggesting diminished kidney function, and for many other abnormal blood test results.
Of course, you’ll want to understand what might be the cause of an abnormal result regardless of the trajectory. But a worsening blood test result usually means the issue is more urgent to sort out.
4. Request copies of your results, and keep them in your own record system. Past laboratory results provide incredibly useful information to health providers, and can be very useful to you as well.
If you keep your own copies of results, you’ll be better able to:
- Share them with new doctors, if you change health providers, move to a new city, or have to go to the emergency room.
- Research your health condition, in order to better understand it and know what questions to ask your doctor.
For instance, one of my family members recently had a “routine” cholesterol panel done. He takes no medications, is quite fit, and is in good health, so he was surprised when some of his results came back higher than normal. We promptly reviewed his previous results, from three years ago, and found that those results were within normal range. So this family member is now in the process of reconsidering his diet.
If he hadn’t had copies of his previous labs, he could have asked his doctor. But it’s much faster and more convenient to be able to look in your own records!
And don’t just rely on looking up past results through a patient portal. Clinics will often remove your access, if you are deemed to have left the practice. So it is very important to keep your own copies of results.
For more on the benefits of maintaining your own personal health record — or a health record for an older parent — see How to Use a Personal Health Record to Improve an Older Person’s Healthcare.
This article was reviewed and minor updates were made in January 2024.
Joseph E Williams says
Estradiol? Progesterone? Testosterone?
Nicole Didyk, MD says
Blood tests for those sex hormones are not usually done on a routine basis in older adults, but may be indicated for certain conditions or symptoms.
sharlene delauter says
The article stated a calcium level is not a good indicator of calcium stores in the body. What is a good test to determine that?
Myriam says
Please tell me if my Amylase test came as 181 U/I is bad. Do I have to worry about problems with my pancreas? I am 73 years old. I have a healthy diet with no red meats, no fry stuff, no alcohol and a lot of fruit and vegetables, chicken and fish. I found out that I have also a fatty liver grade one or simple. Thanks. I am very worry.
Nicole Didyk, MD says
Amylase is an enzyme that humans have in their pancreas and saliva, among other places. An elevated amylase could be related to a pancreas issue, but can also be elevated for other reasons (liver disease for example), and sometimes an amylase level is elevated for no known reason.
I can’t give medical advice over the internet and in general, laboratory tests should only be ordered when there’s a reason to do so, and the results should be discussed with the doctor who ordered the test. I hope your doctor can explore your concerns and help you to avoid unnecessary worry.
Fredrick R Schneider says
I am a 76 year old Vietnam Veteran and would like to find a great place to get a comprehensive blood panel for my overall health so I can compare with what I have been getting yearly at the VA?
Is this possible and where would you suggest I go? I would also like to get this for my lovely wife who is also 76 years old but we both look like and feel like we are in our 60s.
Thank you and Semper Fi.
Leslie Kernisan, MD MPH says
It sounds like you have already established care at the VA and are getting yearly bloodwork, but you’d like to get a blood panel outside the VA to “compare”?
The VA labs are quite reputable, so I’m not sure there’s much value in getting the same tests drawn at a different lab. What is more important is what tests are being done, for what purpose, and how well is this serving your health conditions and your goals for your health. This comes down to the clinician ordering the labs.
If you have concerns about whether you are getting the “right” tests done, and the right actions in response to those tests, I would recommend asking your usual provider to explain why they ordered the tests they did. You would also want to make sure you understand your chronic health conditions and what is considered good care for following those. And you should definitely ask to understand any abnormalities in your results.
If you aren’t satisfied, you could consider a second opinion from another provider, but you’ll have to be sure to find a good one. Hope that helps, good luck!
Takitoteka says
What are your thoughts on testing for magnesium and zinc?
Nicole Didyk, MD says
I don’t usually check magnesium levels unless there are symptoms that suggest it – like other lab abnormalities(in calcium or potassium levels). It isn’t really a part of routine bloodwork. Same with zinc, but I will check a zinc level is someone complains of an altered sense of taste or smell, or if they have a wound that isn’t healing properly.
Susan Kelly says
I am a relatively healthy 65-year-old with no symptoms of anything. My doctor sent me for labs and they took 19 vials of blood one which required prior authorization in all they were 29 tests I have never gone through anything like this before. Is this normal
Nicole Didyk, MD says
That does sound like a lot of bloodwork, but I can’t say if any of those tests were inappropriate without knowing more about your health history, and what the protocols for blood collection are at the lab that you attended. This would be a good question to ask your doctor.
Gladari says
I have tried in vane to find a list/chart of age specific norms for the various blood tests routinely run by our PCPs. Yes, I’ve Googled it and get “these will vary by age”, but no difinitive chart giving the “normal” ranges by age. Are my PCP & I supposed to guess that my higher or lower than “normal” for adults (but not seniors) is OK for me? This blog/forum was the closest I could get, but many of the links are also not senior specific!
This would be most helpful. If it were graduated for every 10 years, like 60, 70, 80+ it wouild be most useful. I go to the links and get the norms for adults < 60 years old! This is very frustrating.
Does anyone have a comprehensive & definitive link or source for a chart or table? If not, might be good work for a grad student or intern.
Nicole Didyk, MD says
I can understand your frustration in not being sure if the normal ranges for laboratory tests are normal for your particular age group. The danger with relying too heavily on tables of “normal” values is that many things can affect what makes a lab value normal for a certain individual. For example, it’s vital to consider sex, age, ethnicity, and underlying conditions when evaluating a lab value.
A physician or nurse should have the clinical skill and up to date knowledge to interpret lab values and put them in context for the particular person they’re caring for.
sea says
I can’t agree more with the original poster – what good are standards when there is not an actual standard published anywhere that everyone uses ie Patients and Doctors? On reviewing my lab tests with a friend who uses a different health care provider (we are both the same age, sex and ethnicity) we discovered significant differences in ranges. So my Doc says, tests all look good except glucose is a little high – compared to my friends normal ranges that would indicate I am already considered a diabetic and other things are out of range being either low or high. It makes no sense these providers aren’t using the same standards and they aren’t available to the public, sure adjust for age, sex ethnicity etc – all possible to be done in the age of the internet. Maybe some results are subject to further interpretation – fine ask your Doc but seriously, this shouldn’t be so subjective especially if you want people to take a more active role in their health. Biggest difference in our providers? My friend is with a premium provider and I am on a lower cost HMO in the US where healthcare is a profit motivated industry.
Nicole Didyk, MD says
I can relate to your frustration and I’m all for patients getting involved in their health management!
There should be standard lab values, but there can be variations depending on the type of test or the laboratory. Still, the information is pretty clear from national guidelines for things like glucose levels and diabetes. The American Diabetes Association has excellent resources, which you could download and bring to a doctor’s visit for discussion. My patients do that all the time and it leads to a productive interaction in most cases.
We have these kinds of issues in Canada too, even with a single-payer system – it can be provider-dependent or due to a range of other factors, but I take your point.
Keith Adren Eaton says
Several of the blood test markers are quite age dependent yet reports show ranges that are not age adjusted and cause the results for a 77 year old man to fall lower that the range for the entire population.
My platelet count at age 77 is indeed lower than at age 63. It was 137 five years ago then went up for a few years and last week back at 137. My GP has me at a specialist tomorrow. Yet published research says for men over 75 the lower limit should be 120.
Is there no age adjusted blood test “Norms” available?
Nicole Didyk, MD says
Hi Kevin and thanks for the question. I’m not a hematologist or an expert in laboratory medicine, but a brief search of the PubMed database revealed several studies looking at what the “normal count” (aka reference interval) for a platelet count should be. It appears that platelet count generally does go down with age, and there may be a lower reference interval for those 75 and over (122 as a lower range for older men, 140 for older women).
It can take a while for reference intervals to change on a broader scale, so your MD is probably looking at a standard table, where a platelet range of 150-400 is considered normal.
Platelet count can go down related to a number of causes including medications, alcohol use, and some hematological issues. A specialist should be able to decide if you need more investigation or a longer period of observation and I hope you get good news!
Gordon says
This enquiry is a little different:
A number of local Patient Participation Groups (PPG’s) met (before Covid – 19 lockdown) to discuss the need to encourage young people to join PPG’s – we each have a preponderance of ageing members.
This imbalance is understandable; young people are not inclined to dwell on illnesses and other medical conditions they are not likely to encounter for a while anyway. However it was suggested that society is moving ever closer to a medical monitoring format with an increasing bias to early detection.
With this in mind we considered the possibility of encouraging young people to take an initial blood test as an introduction to PPG membership. There seems to be several advantages to this idea:
1 The young person benefits from being assessed
2 It seems a sensible way to begin what might amount to a life-long arrangement
3 Early indications of any underlying health problems can be identified
4 The PPG benefits from a better spread of population age membership
5 GP’s have a more comprehensive medical history of patients
6 It will encourage the development of self-testing
If you have time to comment I would appreciate your opinion on this proposal
Nicole Didyk, MD says
So, if I understand your comment – the thought is to encourage enrollment in a Patient Participation Group by offering a blood test as an incentive?
I’m not overly familiar with PPG’s. From a quick search it looks like a PPG is a model that is primarily based in the UK. Is this a form of rostering patients to a particular group of health care providers, or is it more of a patient advisory group? I will assume it’s the latter, and so my answer is based on that.
I would want to be clear about how a person benefits from having a blood test, unless there is a condition that is fairly highly prevalent in your population, detectable by a blood test, and treatable. Needless blood work is never really a good idea, can be costly and burdensome and not completely without risk. I’m not sure what health problems you would expect to uncover in a random sample of participants, and which blood test you would do – a blood glucose test, kidney function, CBC…?
In preparing this answer, I found this article about patients who ask for blood test when they are well. These authors point out that patients often come to rely on blood tests as external validation of their behaviour or health status, or do the tests out of fear or an expectation that blood tests should be done routinely, which is not supported by evidence.
My opinion is that a medically unnecessary blood test is not a good enticement to participate in a PPG, but it’s commendable that your team is thinking about how to engage patients in their health care.
Gordon says
Dear Nicole,
Thank you for taking the time to respond to my enquiry and providing an extensive article relating to the subject of unwarranted blood tests.
My interest in this matter stems, as I mentioned in my earlier message, from an interest in recruiting young members to our Patients Participation Group (PPG) which, along with all other General Practices is a national requirement under the UK NHS institution – I refer to the NHS in this way because it is a revered establishment rather than an enterprise in the commercial sense.
Certainly since the outbreak of Covid, and even before then, attention was being influenced by the advent of digitalised health care and its ability to enable a much greater range of activities, from diagnosis, prescriptive medicine, prognosis through to treatment – not to mention the benefits of greater and rapid access to more accurate and influential data.
The benefits of these advances has enabled far reaching changes to be introduced in how General Practice and Clinical Care is organised and managed – including Social Care for the elderly.
This has opened up possibilities for what is termed Self-Help, whereby individuals in society have greater ability to monitor and control their health and life-styles. These possibilities extend to the concept of monitoring health throughout a whole life-long transition from infancy to old age, along with the identification of signposts that point to developments that may need medical attention in the future.
It was during discussions on these issues that the question arose as to how this monitoring could be carried out, and whether periodic blood tests were the appropriate method. It took only a brief thought to conclude that if this was a suitable method it might be a way of encouraging young people to join a PPG, which generally speaking they are uninterested in doing for obvious reasons.
We are entering a period of great change in health and social services in the UK and elsewhere as a result of which society attitudes will need to embrace its impact. General Practice will also change, perhaps dramatically, as the role of group networks is established together with associated specialist facilities.
I trust you can now appreciate my purpose in submitting the original enquiry.
Nicole Didyk, MD says
Thanks for the information and for filling me in on the NHS. My practice is in Canada and we certainly have a revered single payer medical system as well, but we don’t have a paralell private one (in fact it’s against the Canada Health Act to offer such services).
I heartily support the Self-Help approach in healthcare and I think that individuals do need to be actively engaged, as early as possible to make it work optimally. Building networks is also a wonderful idea.
Still not sure that a blood test is the way to go, if it’s not needed. I wonder about a waist circumference measurement, or some other fitness marker that would be less invasive but still universally relevant? Your team has clearly thought about this a lot, so I am just offering that off the top of my head!
Applause for striving to engage and empower the patients in your care. It will be interesting to see what unfolds.
Lisa Harrison says
Hello! My 85-year-old mother has severe COPD and is also on warfarin. She’s been exhausted for the last couple of years and we figured it was because of the COPD. We just got her up and running on MyChart. Despite having routine doctor visits to lung, heart, and primary doctors, no CBC test has been ordered or given in more than four years. She frequently takes an anticoagulant test which is great, but shouldn’t be having at least a baseline CBC each year to look for other things, like anemia? I’m wondering how often elderly patients need this baseline test. Thank you.
Nicole Didyk, MD says
Thanks for sharing your story.
When an individual is taking warfarin, some regular bloodwork is usually important, as you mention. The “anticoagulant test” is most likely an “INR” which is used to determine if a person is on the right dose of warfarin, with enough anticoagulation to reduce the risk of a clot, but not too high such that the risk of bleeding is excessive. Usually an INR is done every 1 – 3 months in stable individuals.
There’s really no guideline (that I know of) about how often a person on warfarin, or living with COPD, needs a CBC (Complete Blood Count), unless they are having new symptoms. Exhaustion can be related to anemia, especially if it’s associated with other signs like blood loss, bruising or other skin changes, pallor, weight loss, or fevers. But exhaustion can be related to many other conditions as well.
In short, a regular CBC isn’t needed unless there are new symptoms to investigate, but it’s a common part of the work up for numerous complaints, including fatigue.