Annual Labs Guidelines- recommendations

[deleted1053216]

Do you order annual labs for any and all Patients that you see?
I have been told by folks that things have changed and annual labs (i.e. cbc, BMP, UA) are not at all necessary on pts. just because you see them for a physical. What are your feelings towards this? I come from a different era, when it is a custom to order labs annually and then go over those with your PCP during your physical.

Any advice,I would appreciate any AAFP links in this matter, I tried to search but no luck.

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[VA Hopeful Dr]

Yes, based on the evidence we have the standard panel of annual labs isn't necessary on all patients.

My practice is this:

Age 40 and up, physicals get a CBC, CMP, TSH, and lipids.

30-40 get the same but only every 3 years.

20-30 get those one time, if not exceptionally abnormal they don't need it again until they hit 30.

This all assumes patients with no other risk factors. Its not the most evidence based practice, but it works for me.

It also assumes its not an insurance/work physical, in which case I do whatever they say they need to have done.

That all being said, I don't recommend physicals anymore (the evidence doesn't support yearly physicals either). If patients want them, I'll do them but I don't specifically tell people to schedule them.

 

[deleted87716]

I do something similar to the above.

 

[simpler2]

I only order labs based on USPSTF recommendations. These are prone to change periodically and are easy to find so I wont post specifics. There are currently no evidence based guidelines to my knowledge that would recommend regularly checking either CBC or TSH for screening purposes in the average adult patient.

 

[VA Hopeful Dr]

I only order labs based on USPSTF recommendations. These are prone to change periodically and are easy to find so I wont post specifics. There are currently no evidence based guidelines to my knowledge that would recommend regularly checking either CBC or TSH for screening purposes in the average adult patient.

Yep, hence why I said it wasn't the most evidenced based practice.

 

[MedicineZ0Z]

I only order labs based on USPSTF recommendations. These are prone to change periodically and are easy to find so I wont post specifics. There are currently no evidence based guidelines to my knowledge that would recommend regularly checking either CBC or TSH for screening purposes in the average adult patient.

I kind of feel like if someone is asymptomatic with transaminitis or is 45 with asymptomatic anemia - they kinda should know. It's just that many of these people will not be asymptomatic, but a small number will be. And they fall through the cracks of literature and guidelines until they become symptomatic.

 

[AMEHigh]

In my area for people over 30 if it’s first time seeing them I’ll order BMP, A1C and lipid panel. I’ll make it a CMP if they talk about significant alcohol use or weigh a lot. I rarely ever order a CBC or TSH on "routine" labs. Over 40 I’ll order the above labs yearly. I stop ordering lipid panel in the super elderly.

 

[VA Hopeful Dr]

In my area for people over 30 if it’s first time seeing them I’ll order BMP, A1C and lipid panel. I’ll make it a CMP if they talk about significant alcohol use or weigh a lot. I rarely ever order a CBC or TSH on "routine" labs. Over 40 I’ll order the above labs yearly. I stop ordering lipid panel in the super elderly.

I'll offer to stop but I'm always surprised how many 90+ year olds want to make sure their cholesterol is still OK.

 

[FrustratedFamDoc]

I'll offer to stop but I'm always surprised how many 90+ year olds want to make sure their cholesterol is still OK, every 4 months.

Fixed.

 

[cbrons]

Do you order annual labs for any and all Patients that you see?
I have been told by folks that things have changed and annual labs (i.e. cbc, BMP, UA) are not at all necessary on pts. just because you see them for a physical. What are your feelings towards this? I come from a different era, when it is a custom to order labs annually and then go over those with your PCP during your physical.

Any advice,I would appreciate any AAFP links in this matter, I tried to search but no luck.

A UA is never appropriate as an “annual lab” for screening purposes.

TSH screening is not evidence based at all but I understand the urge. Problem is, TSH is very often misinterpreted especially by mid-levels in my area. Here is a repost:

*NOTE: Reasonable Upper-Limit of Normal (RULN) and a caution about the laboratory’s “normal” reference-range for TSH

The commonly cited lab value for the upper-limit of normal is 4.5-5.0 mIU/L. However, “normal” TSH increases with age. ~95% of young healthy patients have TSH between 0.4-2.5 mIU/L. Any TSH above this range may be inappropriately high in this population (despite being in the “normal” range per the lab reference value). For example, in women of child-bearing age who are actively trying to get pregnant, a TSH of >3.0 mIU/L should generally be treated regardless of symptoms. On the other hand, it could be argued that an asymptomatic 80-year old patient with a TSH of 10.0 mIU/L might not need to be treated at all (though there is likely little risk to doing so).