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, experts have recently concluded 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.
Your posts are always interesting. This one is particularly helpful. Thank you so much for writing and sharing your knowledge and practical wisdom.
I’ve been a nurse for 40something years. Friends often call me to ask what I think or know about this symptom or that diagnosis for themselves or a family member. The first thing I ask is about lab work and almost always they have no idea what’s been done or what the results showed. Often they never hear back from the provider and assume”no news is good news” or, even scarier…the symptoms are no better or worse but “they said my lab work looked ok so….”. I always recommended they get hard copies of the results. Thank you for this easy to understand and very comprehensive tutorial. I’m gonna save it and hand it out.
You are absolutely right.
Medical Personnel, especially Doctors, should educate, encourage and empower their Patients with their Medical Records. This will make Patients more knowledgeable about their conditions and aid them to take better charge of their health and records.
Thank you for your feedback. I’m so glad you found this article especially helpful!
Thank you.
Did you not forget the PSA test.
I am 73yo and I have been tested yearly since 2001. 1.8μg/L to 4.23μg/L(2017).Then in 2019, my PSA started to go up from 6.8μg/L to 11.7μg/L then in 2020 13.7 then 16.7μg/L then 22.4μg/L .
Jan 29 2020 I had 12 biopies and 6 on the Right Lobe were G(4+3=7) Grade 3 and a pre-RT Scan showed Tumors in both lobes.
Thanks for sharing your experience. Using PSA for routine screening for prostate cancer is somewhat controversial, and whether or not to get a PSA depends on age, race, personal and family history. I’m glad that PSA surveillance was helpful in your case.
My P.S.A was 3.5 now 0.89 I take dutasteride 0.5 mg one day very good
Listing the blood tests is helpful, but all should know that Medicare doesn’t pay for routine bloodwork. They only pay for diagnostic tests for a suspected problem. So, likely worth the cost, but worth considering.
Good point, Pete. Most of the time in Geriatrics, we order bloodwork to try to sort out a medical symptom and if that’s the case, I hope it would be covered. Here in Canada, where I practice, many, but not all routine tests are covered, and some are only covered at a certain interval.
Dear Dr.,
Extremely helpful and useful for everyone!
Phan S., MD, MPH, PhD(C)
I’m so glad that you enjoyed the article!
Your article is helpful and informative. However, the results of the tests performed by labs use “normal” ranges for 20 – 40 year old patients (generally males). I have found many of the ranges listed as normal, high or low are not those recommended for seniors, those over 65 & sometimes even 75 or 85! For example, you say “A result of 6.5% or above is suggestive of diabetes.” This is not what I’ve found “The American Geriatrics Society gives precise guidelines for the goal of diabetes treatment in over 65ers. The key measure of diabetes control is hemoglobin A1c. For healthy over 65ers with long life expectancy, the target should be 7.0 – 7.5%.” They further have different guidelines for those 75, 85 or with other health issues.
I have had to search many areas to get age-appropriate ranges for these diagnostic tests. PCPs that I’ve had do not seem to be aware of them. I’d really like to see (and have found some) age appropriate charts for blood work & blood pressure. In my opinion, using these age inappropriate lab results could be why so many seniors are over medicated!
I am continuing to search for age appropriate lab tests for the other ones you list in this article. A comprehensive guide would be very useful. Getting doctors knowledgeable about them would be wonderful!
I agree, Dianna and please share any resources you find useful!
Diana, have you found a guide?
Thank You so much for your assistance with so many thing medical. We could really use a whole lot more people working in this field. That being said, it behooves all of us to manage our own care, where possible. Having dealt with Hemochromatosis for 35 years, I can say that keeping all involved focused on my bottom line takes more time than the actual treatment. Thanks again, your effort is appreciated.
Yes, coordination and organization often takes a lot of work. I am sure you have become quite adept after 35 years with a serious condition. Thank you for your feedback.
Thank you so much for your dedication and passion for the health and wellness of older adults and their caregivers.
Thank you for providing such a wonderful space for learning and sharing.
I also have an 82yo Dad I forward your articles to! He reads in prep for his physician visits.
Thank you for all you do!
Be well…
I LOVE the idea of older adults doing a little preparation before their medical visits!
Of course, I don’t want to burden people with work to do, but a little preparation can go a long way towards helping people get more of what they need — and less of what they don’t — out of their healthcare.
Thank you for your feedback, I’m delighted to hear that the articles are helpful.
You said there are ten tests that should be taken by older adults, yet you only list six. What happened to the other four tests.
The first part of the article lists four “panels” that are often ordered: CBC, basic metabolic panel, comprehensive metabolic panel, and lipid panel.
The second part of the article lists 6 additional blood tests that are often ordered.
Hello
I have had a problem with being cold my feet and body for many months.
And now have a problem with shortness of breath.
What kind of test would I need. Thank you.
My doctor said I have excercise and drink a lot of water. I am 91 years
Hi Gerald. I’m not sure that I have enough information to answer your question, but here are some general thoughts. “Cold intolerance” or feeling cold when others don’t is a symptom of thyroid hormone deficiency, so checking thyroid function with a TSH is a good idea. Shortness of breath is a serious symptom that should be discussed with a health care provider and depending on what other symptoms are present, an X-ray or blood test might be required.
Thank you, this is so well-timed. My 98 year old Dad just had his bi-annual physical with all lab results coming back “normal”. He wanted to know what that meant in terms of what the tests were looking for. this will help me interpret them for him!
Glad you find it helpful, thanks for letting me know. I am thrilled to hear of a 98 year old person who is learning more about what his lab work might mean!
Thanks for this detailed article! How can I know if my basic lab results are all a bit out of the normal range due to my being 64 or due to my being long term overweight in the 220-240 range? I am 5’4”. Thank you!
The best thing to do would be to discuss your results with your healthcare provider.
Although it’s common for people to have abnormal lab results as they age, these generally aren’t caused by aging per se, they are caused by a variety of health problems that become more common as people get older. Same goes for being overweight; clinicians generally shouldn’t attribute abnormal results to weight and then just stop there, they should find out just what is the problem and help you with it.
Of course if you are only a little out of the normal range, it can be hard to say whether that reflects a real problem versus just being a bit of an outlier. Again, a healthcare provider who can talk to you, examine you, and review your health history would be in a position to clarify whether your “bit out of the normal range” values are worrisome or not. It also is often helpful to repeat tests after a suitable interval (weeks to months, depending on your situation) to see if the slightly abnormal values have gone back to normal, stayed the same, or gotten worse.
Good luck!
My husand and I have been together for 48 yrs. He has donated blood for all those yrs and some. Many times he was turned down due to a lower hgb, hct and rbc. I went into nursing so I kept records of his labs over the course of 48 yrs. This has been a chronic issue I believe for most of his life. He is or was a marathon runner and ran for most of his life. He is 72 yrs old and still runs . His levels will be normal for months and many even a yr and then slightly go down. Then back up again. Everything else is always normal. Normal B12, Ferritin, Iron, etc. He is always told it is chronic. I discovered by much research that a possible cause was perhaps a methylationn issue. I started to give him converted B6 called P5P. His levels went right back up. But there are side effects with B6 and causes neuropathy. I thought he might have the MTHR gene mutation but his homocysteine levels are normal. Any thoughts of any of this. PS He also has Hashimoto thyroid , which is rare for men.
Hm, his situation sounds more complicated than most. I would recommend consulting with a specialist in hematology, if you are determined to get to the bottom of this. Of course, if it’s a long-standing issue and he is well enough to keep running at age 72, it’s unclear to me whether digging into this is likely to really improve his health, longevity, or quality of life…
Re B6, it’s true that high doses are associated with toxicity. Your husband’s health providers can probably advise him as to whether and how to safely take it. Good luck!
Just wanted to thank you for putting out this information. Sure wish there were more gerontologists in our health care system. Can we clone you? ? I’m sure this blog/site is a lot of work (articles are very detailed), and I really appreciate all you do!
Thank you for this nice comment. I actually HAVE been wishing I could clone myself, as there is more I want to write about for the site but I am perpetually short on time.
Small thing: a geriatrician is not quite the same thing as a gerontologist. Basically, geriatrics is medical, whereas gerontology is more broadly related to aging. All geriatricians have gone to medical school, whereas gerontologists have studied aging and obtained some form of degree or credential in gerontology.
I mention it because over the past several years, I’ve noticed that the public either is surprised to hear that a geriatrician is actually a medical doctor (yes it’s true), or they assume that a gerontologist is a medical doctor (usually not true, although they are certainly quite knowledgeable and do wonderful work and research).
Thank you once again for your interest in the site and in geriatrics!
My 63 yr old spouse recently got lab tests & his RBC was low as well as hemoglobin.
I’ve noticed the hemoglobin has gotten lower even w/adding iron supplement. He looks so pale & is exhausted. His chloride & sodium are low also.
His GP has said nothing, as a retired nurse I am concerned. What are tests we need to follow up with?
I agree it sounds concerning, especially if his hemoglobin continues to get lower and/or he is having worrisome symptoms.
I explain the evaluation and management of anemia — including how to make sure it really is due to iron deficiency — in this article: Anemia in the Older Adult: 10 Common Causes & What to Ask.
Especially if his GP is saying nothing, then you will need to ask more questions. Good luck!
Hello, My mother who is 80 has been feeling more confused and has had increased anxiety. I asked her home nurse to do some blood work. Her hemoglobin is 11.0 her RBC is 3.88 and hematocrit 35.3 Urea nitrogen serum 31 which is high. Her TSH was 0.87
I think this means she is anemic. I plan to ask her nurse to compare to her last blood work done a little over a year ago. How would I know if this is a iron defeciency or a blood loss from something internal anemia? Thank you for any advice you can give.
MCV 91
MCH 28.3
MCHC 31.1
Platelets 294
So, a hemoglobin of 11 would generally be considered mild anemia and I wouldn’t expect it to cause confusion or anxiety. Iron-deficiency usually corresponds with a lower ferritin level. You could ask about this, as it’s possible this is the cause of her mild anemia. For more on anemia see Anemia in the Older Adult: 10 Common Causes & What to Ask.
But if your main concern is confusion and anxiety, then what she needs is an evaluation for things that can cause these symptoms. Some electrolyte imbalances can do this. You could ask her doctor if anything in her labs can help explain her recent confusion and anxiety.
Otherwise, she may need further evaluation for things that cause or worsen problems with brain function, memory, and thinking. These include medication side-effects, delirium, and certain other medical problems. I explain those evaluations in these articles:
How to Diagnose & Treat Mild Cognitive Impairment
How We Diagnose Dementia: The Practical Basics to Know
Good luck!
Hi why am I having my third full body blood count in 6 weeks. My GP mention that my white cell reading was a little high, and was told to have another blood test, having had the results for this one, but now have been told to have another full body blood test. I am a 68yr old female. Pretty healthy. No not diabetic. Have an under active thyroid.
There’s really no way for me to say why your health provider felt it necessary to check your labs a third time. Presumably they saw something potentially concerning the first time around. I would recommend asking him or her to clarify what was abnormal, what it might mean, and what their plan is for further evaluation or possible treatment. Good luck!
You only speak to low levels of B12 being a problem for older adults. Why is there an a normal “range” for B12 from 213 to 816 if you are only concerned with low B12 values? What if a person had a reading of 1203?
In older adults such high levels of vitamin B12 would be uncommon. Also within medicine, “high” levels of vitamin B12 are not considered problematic or worrisome, presumably because we have not identified this as the sign of disease or as hazardous to the body. The lab’s “normal” range reflects what is thought to be normal for most people, but there will always be a few people who fall outside this range. If I came across such a high B12 level on a patient’s lab reports, I would probably start by asking if they are taking a supplement and if they were, advising them that there is no need to keep supplementing vitamin B12.
Dr. Andrew Weil also comments on the risks of excess vitamin B12 supplementation here: Too much B12?
My MIL’s last B12 test was 1800 and her Dr. said not a problem. I read up on it and found that a high B12 could actually be a deficiency–“A check for IF antibodies, homocysteine and MMA in the urine can thus indicate whether the high values of B12 have been mistakenly produced. ” https://www.b12-vitamin.com/high-blood-levels/
She’s on warfarin, Prilosec, Omeprazole, Celebrex, Celexa, has liver lesions, is always dehydrated, afib, and mild COPD along with what her GP is calling Azlehimers. The GP does not recommend a specialist for dementia, nor a liver specialist, because they will say what she said. Time after time labs are way out of range and the GP is fine with it. No matter what I say, no one wants to change GP and it baffles me.
Hello T.B. I’m sorry to hear about what sounds like a very challenging effort to help your Mother-in-law with her medical issues. Focussing on the B12 level, you are right that an elevated level of B12 could be related to a deficiency, or a lack of functionality of vitamin B12 even though that seems like a paradox! Some follow up tests such as methylmalonic acid and homocysteine, a complete blood count, liver enzyme tests, and others, might be a next step. Also, you mention omeprazole, a medication that treats gatroesophageal refulx, and can interfere with the absorption of B12. Alcoholism, liver disease and some types of cancer can also cause an elevated Vitamin B12 result. But taking a step back, it sounds like there may be some communication issues, and here is an article that might be helpful with that. Best of luck!
What hormone testing should be done on elderly patients who suffer from anxiety .all the usual meds for anxiety dont work.so I’m thinking extensive hormone testing should be done.
We don’t generally do hormone testing for anxiety. Depending on an older person’s symptoms and medical history, it might be reasonable initially to check things like thyroid tests, electrolytes, and perhaps some other basic blood tests. But if those are within normal limits, it’s generally assumed that anxiety is due to psychiatric reasons, or possible related to cognitive changes. There is also some interesting newer research on relationship between gut bacteria and mental health, but it’s too early to know how to apply it in regular clinical care.
In general, I would say it can be difficult to manage anxiety only with medications. The ones that tend to provide more immediate relief are sedatives and tranquilizers such as lorazepam (brand name Ativan) or alprazolam (brand name Xanax), but these are problematic since they are habit-forming, worsen balance, and affect thinking speed. Other types of medication can help, but tend to take weeks to generate an effect and even then, it may not feel like enough of an effect.
Cognitive behavioral therapy and other psychological therapies are safer and can be very effective, but they require more time and effort to implement.
In short: often no easy solution for anxiety in older adults. Good luck!
This was a terrific article! I have taken the liberty of sending it on to my Health Services Committee here at the CCRC where I live as well as with my better friends.
I think it is something that most cognitively intact older person should know.
Thanks again for making it plain and simple – but essential information.
sue
So glad you find it useful! Thank you for sharing it with others!
Thanks for this article, so helpful! Question: when do cholesterol numbers become a moot point? My mom is 80 and she still worries about her cholesterol numbers. She doesn’t take a statin, takes Xarelto for a-fib, which appears to be under control, and eats a healthy diet. She still takes a calcium supplement for osteopenia but she also takes Fosamax. Is taking calcium supplements at 80 when you’re taking Fosamax a good idea? Thanks again, you are awesome!
Glad you found this helpful. Cholesterol results are generally considered in the context of a person’s overall risk for cardiovascular disease, the likelihood that they would benefit from treatment to lower cholesterol, and their primary goals of medical care. For some frail older adults with limited life expectancy, it generally does not make sense to follow or treat high cholesterol, because either they aren’t likely to benefit from treatment or because the focus on their medical care is no longer on doing everything possible to reduce the risk of a cardiovascular event.
I go into cardiovascular risk factors in this article:
How to Address Cardiovascular Risk Factors for Better Brain Health: 12 Risks to Know & 5 Things to Do
If your mom has been worrying about cholesterol, I would recommend learning a little more about cardiovascular risk and then discussing with her health providers, to find out whether her worries are warranted and to discuss her preferences and values regarding cardiovascular risk reduction.
As for bone health, a bisphosphonate such as alendronate (brand name Fosamax) is generally recommended to treat osteoporosis, but not really osteopenia. Postmenopausal women should also generally get 1200mg of calcium per day, with as much as possible from diet and then using supplements if necessary to reach whatever calcium intake goal their health provider recommends. If your mother has osteopenia and is on Fosamax, this may be worth revising with her health providers.
Thank you, very helpful! Your kindness in sharing your knowledge is appreciated!
Excellent article! Thank you for all the hard work of putting it all together to keep us better informed.
Thank you, glad you found it helpful.
Thank you so much for this step by step clarification of which most I knew, however, a lot of other incidentals I did not know. I will print this out and place on my desk for future reference.
I’m going for blood work up this week…my platelets and RBC are lower than normal as is my Hemoglobin. I’m usually “stable abnormal normal” with results…But, these have recently dropped…I’m hoping they went up with this new batch coming up.
I’ve been under stress and not sleeping…hoping that’s the reason.
Thank you Doctor…you are so helpful and a God send!
Take care~
Glad you found this helpful. Hope your next round of results is reassuring, and also that the sleep and stress get better.
For me, this is your most valuable column of all.
Thank you for this feedback, always good to know what people find especially helpful.
I thought this was a really excellent article I am a retired pathologist so know this information, but you have presented it so well. I appreciate your very common sense approach to so many topics. Keep up the good work (and take care of yourself!)
Thank you, I’m always delighted when fellow health providers appreciate the articles!
My 92 year old Dad in the Philippines was diagnosed with Atherosclerotic, fusiform abdominal aortic aneurysm (infra-renal) w/ circumferential mural thrombosis last April 2018. He had two mild strokes within the last three years and had pneumonia twice this year. He was hospitalized four times this year. However, he has recovered and doing good with medications and caregiving by my two siblings.
My question is, what is the safe and reasonable frequency of routine doctor check up and lab work for him (except when he is sick and/or hospitalized)? My sister claims his doctor requires a monthly checkup and blood work? Is that too much or not safe for him? Thank you so much for your input.
So, how often to follow up with the doctor and/or check labs really depends on what is going on with a person’s health. It can also depend on how the doctor’s clinic is set up. Many doctors are only able to offer relatively short visits during which they can only address 1-3 issues. So if an older person has lots and lots of ongoing conditions, health providers may schedule more frequent visits, just to have more time to work through all the concerns.
Monthly visits are also a reasonable interval for making sure that a person is responding to a treatment plan, or to see if an older person is declining.
Now does he need bloodwork every time? Again, it depends on what health conditions are being followed. Your family may want to ask for more details re the purpose of the monthly blood draws. Is it because of your father’s BP medications? Or are they following anemia? Something else? If you ask, they should be able to provide details. You could also ask them to explain the downside of waiting two months to do bloodwork (or even a followup visit), and see what they say. The ideal is to provide enough medical care to adequately manage the health problems and help an older person with their health goals, without unduly burdening the older person or the family. Good luck!
What tests are recommended for older adults around 70 yrs with stable health conditions?
The recommended tests would really depend on what stable chronic conditions the person has, and what medications they are taking.
We have more on recommended preventive care for older adults here: 26 Recommended Preventive Health Services for Older Adults: the Healthy Aging Checklist Part 5
thank you for your easy to read & understand guidelines for seniors. There is one glaring issue I wish the medical community would address but, instead routinely dismisses I am 75 and have lived a pretty healthy life, I do not have cholesterol -diabetes-dementia-or other chronic age related problems. I don’t drink, don’t smoke, exercise as much as I want to and eat what I sense I body needs, sometimes carbs, sometimes protein. 3months & 3 doctor visits where I was seen for general thyroid checkup I continued to relate that I was feeling very “unwell…” lethargy. ridiculous low energy, brain fog, lack of taste or concern about food. No temperature, no CBC infection showing–ergo must just be the “old lady” symptom UNTIL IT WASN’T. After sleeping non-stop (because I couldn’t wake up) for 28 hours I awoke to my swollen face & feeling sicker than I have ever felt…..a mid night trip via ambulance to the ER and yes my kidneys were failing, Stage -4- A comprehensive metabolic panel should have been supported by complaints & my over-all health, it was not ordered and now I spend why time trying to regain a more normal kidney function. In short, yes old people are going to die but ignoring symptoms because “age has it’s problems..” is a sad and worrisome state of affairs. Again thank you for offering a user friendly site for all of “us old” people.
Thank you for sharing your story but yikes, it does sound like your kidney function should’ve been checked sooner and I’m so sorry that it wasn’t.
You are right, waving off complaints of fatigue in older adults is often due to ageism.
Best wishes with your recovery and glad you find this site helpful.
wondering why you didn’t include the ranges in your article pointing out the “normal” in each range?
I have provided links for the various tests, so that readers can learn more about what is considered the normal range. It is pretty easy to google and find that kind of answer, so I choose to spend my time providing the additional info that is not so easy to find on google.
Dr. Kernisan,
I’m 70 years old. Drawing my blood has always been quite painful. Recently after routine physical, Dr. ordered blood test (hadn’t had one for 5 years). As usual it was painful and slow, and after drawing one vial, the nurse asked which arm for the second vial. I declined and left. They said I could come back anytime. I can take pain if I know it’s necessary, but putting a needle in my arm and taking blood out of my body seems like a risk to me. IS THERE A BAD SIDE TO BLOOD TESTS besides the pain? Why do they need to take so much blood? Thank you.
Sorry that these blood tests are so painful for you. Most people find them uncomfortable but not frankly very painful.
As far as I know, occasionally drawing blood is not associated with particular risks. They take enough blood for the tests that were ordered, so more tests can mean more tubes need to be filled. (They also need to draw into certain types of tubes for certain tests.)
If drawing blood is so difficult for you, I would recommend making sure your doctor is aware and asking for his or her help in identifying which tests are most likely to be useful, to monitor your health or evaluate a problem you are having. Good luck!
I am 73, male, and have a Ur of 8.6. My last one 2 years ago was 5.8. I cannot find on the internet what Ur stands for. There are a lot of similar abbreviations. Does anyone know what it stands for and should I be worried now that it is out of the normal range and should I be doing anything to get it back into the normal range once again?
Hm. Well, I would recommend asking the provider that ordered the test!
One possibility would be that this refers to uric acid, which has results in the range you describe. A common reason for it to get higher in older men is gout, but there are other possible reasons as well. Do ask your health provider to explain why the test was ordered, and what your results might mean. Good luck!
My husband is 63 and has always been very healthy. He is not on any medication. He is getting large red bruises from the slights bump. They look like the ones my mother used to get when she was on blood thinners. He will get up in the morning and feel ok but if he try’s to get anything done around the house, he will be hack in bed. He mowed the grass on Wednesday and hasn’t been out of bed since and it’s Sunday. He sleeps more hours than I thought anyone could possibly sleep. When he went to the doctor last year for a check up, the doctor told him he was just getting old. I don’t except that. I want to know what’s going on. I have made him an appointment with a new doctor. What are some of the blood tests that I should have them run?
Hm, what you’re describing does not sound like “normal aging” for someone in their 60s. I would definitely recommend a thorough medical evaluation including laboratory testing. There are many many things that can cause fatigue, for someone with his symptoms it’s often appropriate to order a complete blood count, a complete metabolic panel, and also tests related to bruising and clotting, such as the prothrombin time. Good luck!
How do I get a copy of article above re. Laboratory Tests, etc. Retired from hospital, not Lab., and know many of acronyms for blood test results, which is what I was looking for when I saw this article. Very beneficial information.
Please advise,
Annie
I’m glad you find the article helpful. At the end of the article, before the comments section, you should see a small print icon. If you click it, it should generate a print-friendly version of the article. Hope this helps.
Thank you for the valuable information. Do you know if there ya a test to fit sulphur deficiency? Thank you!
Sorry, I’m not familiar with sulfur deficiency and it doesn’t show up in the clinical reference guide I use (Uptodate.com). I also don’t find much on it when I search PubMed, so sounds like it’s not really considered a condition by the medical mainstream. The MayoClinic site shows that urine sulfate can be tested as a way to assess protein intake: Sulfate, 24 Hour, Urine.
In preparation for my upcoming physical the end of this month, I Googled “helpful blood tests.” Your article showed up on the first page of the results. So educational and helpful with lots of useful info – I printed it out and am going to share it with my PCP! Surely it takes a massive amount of time and diligent research to put together articles like this! Thank you for caring and for your passion and dedication to help those of us who are aging. … I went over to your website and subscribed… Thank you, Dr. Leslie! I wish you much more success in all your pursuits! 🙂
Sorry for delayed reply, we had a glitch in our system that we have just resolved.
Thank you for this comment, I’m so glad you found the article helpful and hope it will help you discuss your health with your doctor. Take care!
Had a doctor’s blood test requisition and I obtained a copy of the results.
Disappointed that the results were for only 3 of the 7 items you mentioned for Basic Metabolic Panel.
With your help, I will now be getting more involved in my own health care.
I will be requesting more tests. Thank you.
Good on you for getting a copy of your results.
It has actually become more common for health providers to order just a few of the basic metabolic panel items. It’s probably less wasteful to do this, as one often doesn’t need to know some of the items (e.g. chloride is only rarely useful).
In the future, you could ask your provider to explain what is being ordered and why, at the time you get the requisition. Good luck!
You include LDL ( calculated) but not PLAC – which is much more useful. Why not include it?
The PLAC test is a measurement of the level of an enzyme called lipoprotein associated phospholipase A2 (Lp-PLA2) which is also known as Platelet-activating factor-acetylhydrolase. There have been numerous studies looking at the risk for heart attack and stroke that have included measurements of Lp-PLA2 and results have been conflicting. It is not known whether Lp-PLA2 contributes in some way to the development of heart disease and stroke, or just happens to be elevated in some individuals who have a higher risk of those events for some other reason. Currently, PLAC testing is only recommended for individuals who are at some risk for heart attack or stroke but who have no symptoms, and it’s not a very strong recommendation at that. Bottom line: If you are at risk for heart attack or stroke and you have an elevated PLAC test, it probably won’t change the advice your doctor gives you, so will just be an unnecessary expense and hassle for you.
If a doctor suggests a PLAC test, it is worth a discussion to clarify how the test will provide additional information that might be important for your particular health care journey.
Do you use a table of geriatric normal values? I find that my parents’ (late 80s) doc does not, and calls it “renal dysfunction” for a creatinine 1.2 and GFR 55. I looked up geriatric normal values on line and found these to be completely normal.
You make a great point about considering lab results in the context of the person, not just the number! Kidney function tests are a great example of that. Kidney function does go down with age, almost universally, so the tests that we use to measure and define kidney function tend to be less accurate in older adults. On top of that, older adults are different from each other just as much as they are different from younger adults (for example an older adult with a low muscle mass would have a different calculated GFR than an older adult with a higher muscle mass). All of that to say, I don’t use a table to interpret the results of my patients, but I do interpret those results in the context of the whole person, and take into account the person’s body mass, body composition, ethnicity, medical diagnoses, as well as their age.
This site is the most intelligent and helpful site of its’ type that I’ve been able to find on the internet. Thanks so much for your expert advice. I wish my doc was half as caring as you are Dr. Kernisan.
Sincerely
Chas. Rumsey
Thank you so much for your feedback, I appreciate it and it means a lot to me.
I am a retired Family Practice physician…90 years old. I have been trying to find a Geriatrician in the San Diego area, but have been unable to find one who is taking new patients. I will continue to search. Your article on understanding your lab work is excellent. Thank you for such clear explanations.
I’m so glad if you’ve found the information here helpful. Sorry you are having trouble finding a geriatrician though! I have all my suggestions here: How to find geriatric care — or a medication review — near you. There might be an idea there you haven’t tried yet? Good luck and I hope you find a suitable provider soon.
Thank you so much for providing your expertise on how to treat and care for older adults. The information you provide are easy to follow and help me understand the importance of how to manage my own health, health of my family and friends in the community.
Your information are incredibly useful!
On behalf of Dr K and the team at BHWA, thank you for the feedback! I’m so glad you found it helpful and worth sharing.
My doctor wants to charge me $0.75 cents per page for my lab results. I thought that HIPA mandates them to be released free of charge. She says New York State allows her to charge $0.75 cents per page, even though these are all electronic records. What can I do?
Hi Eric. From what I gather from an internet search, you can be charged up to $0.75 per page for a medical record, and lab results would probably be in that category. However, it appears that you cannot be denied access to the record if you are unable to pay.
I have a son who’s celiac, I’m beginning to
Wonder if I may be too. At 84 had been feeling fine and very active. Started having bicep pain. Finally saw doctor and went on Advil and muscle relaxer didn’t work, went back. He did blood work which was fine except for sed of 69. I’m on 5 day low prednisone but feel terrible. If all blood work was normal could I be having celiac symptoms. Dr don’t like my suggesting it’. Thought it maybe fibromyalgia but I feel so awful like a truck r@n over me. Know celiac testing isn’t common but should I ruleit out since I really don’t think fibromyalgia would make me feel so bad. Thank you for any response you may give.
Hi Nancy, and sorry to hear about your difficulties. I am not sure if I follow your story, but it sounds like your doctor was considering a diagnosis of Polymyalgia Rheumatica, or PMR, which is different from fibromyalgia, and is treated with prednisone. The symptoms you describe could be related to a lot of different disorders, and celiac disease would probably not be at the top of the list. Celiac disease usually causes stomach symptoms like diarrhea and/or constipation, bloating and weight loss and can also contribute to anemia and osteoporosis. I hope you feel better soon and have plans to follow up with your doctor.
I know you’ve answered this question for others but I would like your specific take on how often blood work should be ordered for a healthy 89 year old. My mother is on coumadin, metoprolol and cartia (all for afib). Her BP is normal and her last blood work done 3 months ago was perfect.
Her doctor is ordering blood work again and requesting that she come in for 3 month visits. Money is a concern and we are trying to stretch what she has as long as possible. In your opinion, are 3 month intervals for blood work without any concerns from the doctor reasonable?
Thanks for all the information and help you provide!
Hi Mary. You probably know that warfarin is a blood thinner, which many older adults are taking to prevent a stroke related to atrial fibrillation (irregular heartbeat), or because of a blood clot in a vein or the lung, or some other reason.
Warfarin is tricky because its effectiveness can be affected by certain foods, other meds, and other medical conditions, so monitoring is pretty important and is done by way of a blood test. Checking what’s called an “INR” every 3 months is probably the minimum monitoring for most people. However, some people on warfarin can swap it for a newer type of medication, a direct oral anticoagulant (DOAC) which may require less monitoring. This might be worth finding out.
Hello, my 85-year-old mother was just diagnosed with osteoporosis (via DXA). Her provider did not order any bloodwork. Mom doesn’t have a big appetite and rarely goes outside, so I asked if we could check her Vitamin D. Her level was 10 (should be 20-50), so she has been prescribed high doses until her 3-month re-check. Are there other labs you would suggest that relate to bone health?
This podcast about Vitamin D might be of interest: https://betterhealthwhileaging.net/podcast/bhwa/vitamin-d-healthy-aging-dose-faqs/#more-2132
In Canada, where I practice, the latest clinical practice guidelines recommendation for additional bloodwork is not strong (Grade D) and is only for individuals who may be at risk of so called secondary causes of bone loss.
The additional blood work could include: Calcium, corrected for albumin, Complete blood count, Creatinine, Alkaline phosphatase, Thyroid-stimulating hormone, and Serum protein electrophoresis (for patients with vertebral fractures).
had blood work in 2019 and my %3m was 15.3 latest biood work in may 2020 it is 17.8 should i be concerned ? l’m 80 year old female. My np said it is normal
I’m not sure what a “%3m” measures but it’s reassuring that your health care provider feels it’s normal.
Hello, Curious, my blood work came back with some changes although I do have some previous health issues they have pretty much always came back normal. Should once you change your diet and go off some things you were on before per Dr. Should you get a retest on your blood work before going to another specialist? Just curious and how long should you wait before getting follow up blood work?
Thank you very much.
Blood tests can be a part of the management plan of numerous conditions, so it really depends on a person’s health history as to how often they need a blood test. Dietary and medication changes can definitely affect the results of blood tests. Some specialists will request specific tests be done ahead of the consultation visit so it may be helpful to call ahead and find out if this is a part of the intake process.
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.
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.
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
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.
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.
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.
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?
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!
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.
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.
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.
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.
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
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.
What are your thoughts on testing for magnesium and zinc?
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.
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.
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!
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.
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.
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?
Estradiol? Progesterone? Testosterone?
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.
Thank you so much, you just made everything simple..
My doctor ordered a ferritin test after hemoglobin was 15.9. I am a healthy 67 yr old female and take no prescription medication. My ferritin level is 457. I also tested positive for c282y heterozygous. Dr has suggested phlebotomy. My question is with my platelet count being 150,000 can I tolerate phlebotomy? Will this affect my platelet count?
Hi Linda. I’m not a hematologist, but as far as I know from my reading, platelet counts aren’t usually affected by phlebotomy (the removal of blood at regular intervals to try to reduce iron overload in patients with hemochromatosis and other conditions).
Hereditary hemochromatosis is often due to genetic mutations, like the c282y mutation, and most of the time homozygous individuals (having 2 copies of the gene so to speak) have more symptoms than heterozygous ones (one copy). From what I’ve read, heterozygous people do not usually require phlebotomy. But they might if they have other medical conditions like liver disease, for example. This website might be helpful: https://www.hemochromatosis.org/
I am a retired Medical Technologist (ASCP) and just cannot help myself as I follow the Lab values of my husband and sons.
Husband: Hbg: From 2016 to now, his value has gone from 14.6 to 12.7. His RBC has gone from 5.2 to
3.8 in the same period of time.
I realize things change with age, but I still have a concern about this.
He complains of fatigue.
He has been taking Iron Glycilate 28 mg daily….which I also take and now my hgb is a bit higher than his.
What do you think?
Hi Carolyn and I completely understand looking at a family member’s lab results! For my clients who have “medical” family members, I actually appreciate it when we can chat about lab values and I know that the family member has some background.
The changes you describe are subtle, and not low enough to raise an urgent alarm, but definitely a drop. In a case like that, I would want to round out the workup with some other parameters, such as a complete blood count, mean cell volume (to see if the red blood cells are large or small – this can point to certain types of anemia), kidney and liver function tests.
Anemia is more common in older adults, so if we see a change in blood test results, it’s worth looking more closely, rather than dismissing the change as due to aging. Dr. K has a great article about anemia, which you can read, here.
Thank you. I was shaken to read “Be sure you understand why a given test is being ordered. ” It is just so obvious but I never dare ask these things! I think I need help with how to speak to my Doctor. I often feel as though my GP is irritated by me. I have several painful conditions, live alone, am raging and struggling. But I try hard not to trouble my GP. Recently I felt I could not go on as the pain has become so bad but she became frustrated because I have pain in lots of places and made me choose just one. I really need to go back as I cannot stand up for more than a few minutes now. But she said I did not need to go back. What can I do? Am I a difficult patient?
Lesley, you should know that you’re not alone living with pain. There are millions of people of all ages who live with pain and have a hard time finding help.
Peer support can be very valuable for someone with chronic pain, such as a the forum at painconcern.org.uk. Although I haven’t participated in this forum, I know that many of my patients get tremendous support and helpful tips from peers in the same boat.
Visits with a physician can be intimidating. I know as a doctor, I may feel frustrated with a patient’s problems, but that doesn’t mean I feel frustrated with the patient themselves. That being said, there is sometimes a point where a patient doesn’t need to come back and see me, even if there symptoms aren’t completely resolved. I may need to refer a patient to another doctor who can better help with a particular condition.
Tips for talking to your doctor can include:
1. Making a list of concerns so that you don’t forget to mention something important
2. Bring a friend or family member along for support
3. If your doctor prefers to focus on a single issue, have a priority topic in mind for each appointment, and schedule another visit to talk about the other things.
4. Consider taking notes to make sure you understand what’s being said. A patient may hear: “You don’t need to come back”, when what was said was: “Come back if you have new or worsening symptoms”