Bun Reading of 22 in 75 Year Old Woman

In this article, I'll address a real mainstay of mod medicine: laboratory tests that require drawing claret.

This is sometimes referred to as "checking labs," "doing bloodwork," or even "checking blood."

Virtually older adults have been through this. For instance, it'south pretty much incommunicable to be hospitalized without having bloodwork done, and it'south part of most emergency room care. Such testing is besides often washed every bit office of an annual exam, or "complete physical."

Last but not least, claret testing is usually — although non e'er — very helpful when information technology comes to evaluating many common complaints that affect aging adults.

Fatigued and experiencing low energy? We should maybe check for anemia and thyroid problems, amid other things.

Dislocated and febrile? Bloodwork can help united states bank check on an older person'due south electrolytes (they tin be thrown off by a medication side-effect, as well every bit by other causes). Claret tests tin can also provide us with information related to infection, kidney function, and much more than.

Similar much of medical intendance, claret testing is probably overused. But frequently, information technology'due south an appropriate and an important part of evaluating an older person'southward health care concerns. Then as a geriatrician, I routinely order or recommend blood tests for older adults.

Historically, laboratory results were reviewed by the doctors and were just minimally discussed with patients and families. Merely today, it'south becoming more common for patients to inquire questions about their results, and otherwise become more knowledgeable about this aspect of their wellness.

In fact, i of my peak recommendations to older adults and family unit caregivers is to ever request a copy of your laboratory results. (And and then, proceed it in your personal health record!)

This way, if yous e'er have questions about your health, or demand to meet a dissimilar dr., you'll be able to quickly access this useful information most yourself.

In this commodity, I'1000 going to list and briefly explain the blood tests that are well-nigh commonly used, for the primary medical intendance of older adults.

Specifically, I'll encompass four "panels" which are commonly ordered, and then I'll listing six more blood tests that I detect especially useful.

In other words, we're going to cover my top 10 blood tests for the healthcare of crumbling adults.

I'll finish with some practical tips for y'all to keep in mind, when it comes to blood tests.

4 common "panels" in laboratory claret testing

1. Complete Blood Count (CBC)

What information technology measures: A CBC is a collection of tests related to the cells in your blood.  Information technology usually includes the following results:

• White blood cell count (WBCs): the number of white blood cells per microliter of blood
• Cherry blood cell count (RBCs): the number of scarlet blood cells per microliter of blood
• Hemoglobin (Hgb): how many grams of this oxygen-conveying poly peptide per deciliter of blood
• Hematocrit (Hct): the fraction of blood that is made up of ruddy blood cells
• Hateful 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 tin 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 claret cell count differential, and what the results might signify, see Medline: Claret differential test.

What the CBC is oftentimes used for:

• Anemia may be diagnosed if the red blood cell count, hemoglobin, and hematocrit are lower than normal.
  • I explicate anemia in more depth here: Anemia in the Older Adult: 10 Common Causes & What to Enquire.
• The white blood cell count usually goes up if a person is fighting an infection. Some medications, such as corticosteroids, can also crusade an increment in the white blood cell count.
• If several types of blood cells (i.eastward. cherry blood cells, white blood cells, and platelets) are low, this tin can be a sign of a problem with the os marrow.
• Occasionally an older person'south platelet count may be lower than normal (or fifty-fifty higher than normal). This usually requires farther evaluation.

ii. Basic metabolic panel (bones electrolyte panel)

What information technology measures: Although it'south possible to asking 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-furnishings tin can cause electrolytes such as sodium or potassium to be either as well high or too low.
  • These electrolytes are frequently monitored when people take sure types of medications, such as certain blood pressure medications, or diuretics.
• Carbon dioxide levels reflect the acidity of the claret.
  • This can be affected by kidney office and by lung function. Severe infection can also change acrid levels in the blood.
• Creatinine and BUN levels are about normally used to monitor kidney function. Both of these measurements can go up if kidney function is temporarily dumb (e.k. by dehydration or a medication side-effect) or chronically dumb.
  • It is common for older adults to take at least balmy decreases in kidney function.
  • Many medications must be dosed differently, if a person has decreased kidney function.
  • Laboratories now routinely utilise the patient'due south 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 carbohydrate 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 acquired by diabetes medications, and may point a demand to reduce the dosage of these drugs.

For more than details on these tests, meet Medline: Basic Metabolic Panel. From this folio, you lot tin notice links to boosted 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 information technology measures: This console includes the items in a higher place in the basic metabolic panel, and so ordinarily includes an additional seven items. For this reason, it's sometimes referred to as a "chem-14" panel. Across the seven tests included the bones panel (see above), the comprehensive panel too 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 non commonly a good way to assess calcium intake or total calcium stores in the bones and body.
  • High or low blood calcium levels can crusade symptoms, including cognitive dysfunction, and ordinarily indicate an underlying health trouble. They can also be caused by sure types of medication.
• Albumin is one of the primal proteins in the bloodstream. Information technology is synthesized past 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 independent in liver cells.
  • An elevation in these enzymes often indicates a trouble affecting the liver. This can be caused by medications or by a variety of other health weather condition.
• Bilirubin is produced by the liver, and usually drains downward 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 exist acquired by gallstones or some other upshot blocking the bile ducts.
• Alkaline phosphatase is found throughout the body, simply particularly in bile ducts and also in os.
  • Higher levels are often caused past 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.

iv. Lipid (cholesterol) console

What it measures: These tests measure the different types of cholesterol and related fats in the bloodstream. The console usually includes:

• Total cholesterol
• Loftier-density lipoprotein (HDL) cholesterol, sometimes known as "skillful" cholesterol
• Triglycerides
• Depression-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 earlier having their cholesterol checked. This is because triglycerides can increase after eating, and this tin cause a falsely low LDL to be calculated. However, research suggests that in most cases, it's not necessary for people to fast; it'due south inconvenient and but makes a small difference in exam 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 than on these tests, meet Medline:  Cholesterol testing and results.

6 more blood tests that I guild oftentimes

Here are half-dozen other types of tests that I often order on my older patients:

1. Tests related to thyroid function

What these mensurate: These tests can be used to screen for thyroid disorders, or to help calibrate the dosage of thyroid replacement medications.  The virtually unremarkably used tests are:

• Thyroid stimulating hormone (TSH)
• Free thyroxine ("free T4" or FT4)

In more than complicated situations, other tests related to thyroid office may also be ordered.

What these tests are often used for:

• Thyroid bug are common in older adults (especially older women), and are associated with symptoms such as fatigue and cerebral difficulties.
• If an older person is having symptoms that could be related to a thyroid problem, the first step is to cheque the TSH level.
• TSH usually reflects the body'due south conclusion 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.
• Gratuitous T4 is often used to confirm a thyroid hormone problem, if the TSH is abnormal.

For more information virtually thyroid problems in older adults, see HealthinAging.org: Thyroid Issues. You tin also read a more in-depth scholarly article here: Approach to and Treatment of Thyroid Disorders in the Elderly.

ii.  Tests related to vitamin B12 levels

What these measure: These mensurate the serum levels of vitamin B12 and provide information as to whether the level is adequate for the torso's needs.  The two tests involved are:

• Vitamin B12
• Methylmalonic acrid

Depending on the situation, if an older adult is constitute to have low vitamin B12 levels, additional testing may be pursued, to determine the underlying cause of this vitamin deficiency.

What these tests are oft used for:

• Vitamin B12 deficiency is quite common in older adults, and can be related to common problems such as fatigue, retentiveness bug, and walking difficulties.
• Methylmalonic acid levels in the trunk are related to vitamin B12 levels, and can assist ostend 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 than information, meet: How to Avoid Damage from Vitamin B12 Deficiency.

3. Glycated hemoglobin (Hemoglobin A1C)

What it measures: Glycated hemoglobin is formed in the body when blood glucose (claret sugar) attaches to the hemoglobin in crimson blood cells.  Information technology is normal for glucose to practise this, merely if you lot have more glucose in the claret than normal, your percentage of glycated hemoglobin will be higher than normal. The higher one'due south average blood sugar level, the greater pct of glycated hemoglobin one volition have. A upshot of 6.5% or above is suggestive of diabetes. For more information:

• Hemoglobin A1C examination

What this exam is unremarkably used for:

• This test is most oftentimes ordered to monitor the blood sugar control of people with diabetes.
  • Whereas a blood glucose level (which tin can be checked past fingerstick or equally part of a bones metabolic panel) reports the blood glucose level at a specific moment in time, a hemoglobin A1C reflects how loftier a person'southward blood saccharide has been, on average, over the prior three months.
• A hemoglobin A1C test can as well exist used equally function of an evaluation for possible diabetes or pre-diabetes.
• Older adults should work with their doctors to determine what A1C goal is correct for them. It is often appropriate to aim for a slightly college goal in older adults than in younger adults. For more on this, run across HealthinAging.org: Diabetes Intendance & Treatment.

4. Prothrombin fourth dimension (PT) and International Normalized Ratio (INR)

What information technology measures: These two tests are used as a measure out of how quickly a person's claret clots. People taking the blood-thinner warfarin (make name Coumadin) must take this regularly monitored. For more information:

• Prothrombin time (PT)

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 two.0 and three.0.
  • The about common reason older adults take warfarin is to prevent strokes related to atrial fibrillation.
  • Warfarin may also exist prescribed subsequently a person has experienced a blood clot in the legs, lungs, or elsewhere.
• The prothrombin time is as well sometimes checked if in that location are concerns virtually 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 proper noun, BNP levels are mainly checked considering they chronicle to heart role (not brain function!). BNP levels get up when a person's eye cannot pump claret as effectively as it should, a problem known every bit "center failure." For more information on this test:

• Brain natriuretic peptide (BNP) exam

A related, just less ordinarily used, examination is the "Due north-terminal pro-B-type natriuretic peptide" (NT-proBNP) test.

What this examination is used for:

• Checking a BNP level is mainly used to evaluate for new or worsening heart failure. This is a mutual 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 jiff tin can be caused past several different bug, including pneumonia, chronic obstructive pulmonary disease, pulmonary edema, angina, and much more.
  • A depression BNP level means that at that moment, the shortness of breath is unlikely to exist due to heart failure.
• Checking BNP levels over time is too sometimes used to monitor a person'south heart failure and response to treatment.
• For more than about heart failure, come across MayoClinic.org: Heart failure tests and diagnosis and also HealthinAging.org: Center failure.

6. Ferritin

What it measures: The body's serum ferritin level is related to iron stores in the body. For more than near this test:

• Ferritin

Depending on the situation, if an older person's iron levels need further evaluation, additional tests tin be ordered.

What this exam is used for:

• Ferritin levels are nigh commonly used as part of an evaluation for anemia (low scarlet claret prison cell count). A low ferritin level is suggestive of iron-deficiency, which is a mutual cause of anemia.
  • Studies estimate that only a third of anemias in older adults are due to deficiencies in atomic number 26 or other essential elements.
  • It's important to confirm iron deficiency by checking ferritin or other tests, before relying on atomic number 26 to treat an older person's anemia.
• Ferritin levels are also influenced by inflammation, which tends to make ferritin levels rising.
• If the ferritin levels are deadline, or if there are other reasons to be concerned about an older person's power to manage atomic number 26, 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: ten Common Causes & What to Ask.

Obviously, in that location are many more tests that tin be ordered as part of the medical care of older adults. But the tests I cover above are, by far, the ones I gild the well-nigh often.

Tips to assist you lot benefit from your claret tests and results

Here are my summit tips:

1. Be sure you understand why a given test is being ordered. Is it meant to assist evaluate a symptom? Monitor a chronic condition? Assess whether a handling is working?

You will empathize your own wellness issues improve, if you ask questions about the purpose of the blood tests your doctors are proposing.

In general, blood tests should but be ordered for a reason, such every bit to evaluate a concerning symptom, to monitor a chronic disease, or to bank check for certain types of medication side-outcome.

Keep in mind that it's just occasionally appropriate to order blood tests for "screening." A screening test means a person doesn't have any symptoms. Such screening claret 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, run across 26 Recommended Preventive Health Services for Older Adults.

2. Enquire your doctor to review the results and explain what they mean for your health.Try to look at the report with your doc. It'due south especially of import to ask about any result that is flagged equally aberrant by the laboratory system.

For instance, I take found that many older adults are unaware of the fact that they accept balmy 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 role is abnormal?

Well, if it's been going on for a while, the md might remember the older person already knows about this issue. Or perhaps the doctor mentioned information technology before, merely the older person didn't quite hear it. It'southward also not uncommon for doctors to just not go around to mentioning a mild abnormality that is pretty mutual in older people, such as balmy anemia or mild kidney dysfunction.

iii. Ask your medico to explicate how your results compare with your prior results. Laboratory reports will e'er provide a "normal" reference range. But what'south usually more useful is to see how a given upshot compares to your previous results.

For instance, if an older person'due south complete blood count (CBC) shows signs of anemia, information technology's very important to look at prior CBC results. This helps us determine what the "trajectory" of the claret count is. A blood count that is drifting down — or worse yet, dropping fairly all of a sudden — is much more concerning than one that has been lower-than-normal, simply stable for the past year. Ditto test results suggesting macerated kidney function, and for many other abnormal blood test results.

Of course, you'll want to understand what might exist the cause of an abnormal consequence regardless of the trajectory. But a worsening blood test result usually means the issue is more than urgent to sort out.

4. Request copies of your results, and go along them in your own record organization.Past laboratory results provide incredibly useful information to wellness providers, and can be very useful to you lot too.

If y'all go along your own copies of results, you'll be better able to:

• Share them with new doctors, if you alter health providers, move to a new city, or have to get to the emergency room.
• Research your health status, in order to better sympathise information technology and know what questions to enquire 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, then he was surprised when some of his results came back higher than normal. We promptly reviewed his previous results, from 3 years ago, and institute that those results were within normal range. And so this family member is at present in the process of reconsidering his diet.

If he hadn't had copies of his previous labs, he could have asked his dr.. Just information technology's much faster and more convenient to exist able to look in your own records!

And don't just rely on looking up past results through a patient portal. Clinics will oftentimes remove your admission, if you lot are accounted to accept left the practice.  So it is very important to keep your ain copies of results.

For more on the benefits of maintaining your own personal health tape — or a health record for an older parent — see How to Apply a Personal Wellness Record to Improve an Older Person's Healthcare.

This article was showtime written in 2017. Information technology was reviewed and minor updates were made in January, 2022.

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Source: https://betterhealthwhileaging.net/understanding-10-common-blood-tests-in-aging/

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