What blood tests should I get at my annual physical, and what do they mean?
In most instances, an annual exam is usually uneventful. Your doctor will ask how you’re feeling, perform a brief exam and may order some blood work. The results are posted in your electronic health records a few days later, or you may get a phone call to inform you that everything is normal. Many patients don’t give it another thought until the next physical rolls around.
But should you be paying more attention to the results of these tests? And what blood tests should you be getting? There are some basic tests that most doctors will order annually or semiannually. Other more specialized tests depend on your family history, personal medical history and current health.
“That’s why it’s so important to have a relationship with a primary care provider,” says nurse practitioner Thomas Strawmier, APRN-NP.
“A provider that you see on a regular basis is going to have a good read on you and will be able to be more proactive in helping you stay healthy and preventing future health issues.”
Either way, it’s important to have a good conversation with your primary care provider about any new symptoms or health issues you’ve been having, in addition to any new insights about your family history. “These conversations will help your provider determine if there are tests above and beyond the basics that should be ordered,” notes Strawmier.
The following is a rundown of common lab tests your provider may order or tests you may want to request annually or at least every few years.
Complete blood count (CBC)
A complete blood count is a standard blood test done at your annual physical that provides a picture of your blood. This includes a breakdown of your red blood cells, white blood cells, platelets, hemoglobin and hematocrit. High or low levels can provide insight into whether you are having issues with your bone marrow, immune system or if you’ve been affected by a virus or other environmental issues, says Strawmier.
Comprehensive metabolic panel (CMP)
This test reveals information about how your liver and kidneys are functioning and details about your electrolytes, potassium, sodium and calcium, which are indicators of whether you are dehydrated. It includes fasting blood glucose, which can be an indicator for predicting diabetes risk or blood sugar imbalances.
Hemoglobin A1C (HbA1C)
This is one of the best tests for getting information about blood sugar issues, insulin resistance and prediabetes. The higher your A1C, the higher the estimated blood glucose. An elevated A1C may indicate your body is not producing enough insulin (or your insulin isn’t working effectively) to move the glucose from the blood into your cells, a sign of prediabetes or diabetes.
Standard lipid panel
This measures your HDL (good) cholesterol, LDL (bad) cholesterol and triglycerides. A baseline should be done between the ages of 35 and 40 unless you have a family history of obesity or heart disease. Optimal levels include total cholesterol under 200, triglycerides under 150, an HDL of 39 to 60 and an LDL of 130 or below.
“A high LDL level increases your risk for heart disease,” says Strawmier. “If your HDL is elevated, you and your provider should discuss lifestyle changes to reduce your level and help prevent future heart disease.”
An advanced lipid panel is a test that might be considered for someone with an elevated cholesterol level or a genetic cholesterol issue.
Your provider may want to order this test if you have high blood pressure or have complained of tiredness, lack of energy, focus or heart palpitations. Thyroid issues are fairly common, affecting 1 in 10 women. “This is a test I usually don’t order unless a patient complains of some of these symptoms or has a family history of thyroid disease,” says Strawmier.
Prostate screening (PSA)
A prostate-specific antigen test is recommended for all men by age 50 to check PSA levels. PSA is a protein made by the prostate gland. An elevated PSA may indicate prostate cancer, benign prostatic hyperplasia or BPH, or inflammation of the prostate.
“If you are taking a vitamin D supplement, you probably don’t need your calcium levels checked,” says Strawmier. “This is not a common test I would order unless there are indications for it, such as chronic fatigue or depression.”
Individuals with long-term problems like rheumatoid arthritis should have their levels monitored because low vitamin D can reduce the effectiveness of treatment, he says.
This is a test you may want to consider if you have chronic fatigue, lack of energy, heavy menstrual cycles, or if you have had any stomach issues such as gastric bypass or absorption difficulties, notes Strawmier.
An anemia panel tests for key nutrients such as iron, ferritin, folate and vitamin B12. Low vitamin B12 is more common among vegans and vegetarians. People with malabsorption issues due to antibiotic overuse, celiac or Crohn’s disease may also have low B12 levels. Folate is important in women who are pregnant or trying to conceive as it helps protect against congenital disabilities. Menstruating women, especially those with heavy periods, may be at risk for low iron levels. It’s also interesting to note that you can still have low iron levels even if you're not anemic.
After your labs are completed
When your labs come back, your provider will review them and look for potential issues. If they see a red flag, an additional test may be needed. If there are no issues, you may receive a phone call from your provider’s office, or the lab results will be posted in your One|Chart Patient portal with corresponding notes for you to review at your convenience.
Before you leave your annual physical, it is important to discuss with your provider how you would like to do a follow up on your labs. This might include a phone call from office staff, a telehealth visit or posting them to your electronic records.
“Maintaining a regular primary care provider, staying current on your annual physicals and having an open and honest relationship with your provider will go a long way in helping you stay healthy and be proactive in your health,” says Strawmier.
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