Commonly used Laboratory Blood Tests for older Adults

• April 21 ,2023

The hub of modern medicine is laboratory tests that require drawing blood. Sometimes it is often referred to as ‘checking blood’, or ‘checking labs’, or even ‘doing bloodwork’.

Most older adults have experienced this. For instance, it is quite impossible for you to be hospitalised without having bloodwork done, and it’s part of most emergency room care. It can also be part of an annual exam or ‘complete physical’.

When it comes to evaluating problems affecting ageing adults, blood testing is very helpful.

Are you tired and down with low energy? Perhaps, checking for anaemia and thyroid problems, among other things could help.

Are you confused and delirious? Doing bloodwork can monitor an older person’s electrolytes (they can be thrown off by a medication side-effect, as well as by other causes). Information about kidney, infection, and much more can be provided with blood tests.

Just like medical care, blood testing is probably overused. But often, it is an ideal and a crucial part of evaluating an older person’s healthcare concerns. Hence we recommend blood tests for older persons.

In the past, laboratory results were revealed by doctors and were minimally discussed with family and patients. But in recent times, it is a common practice for patients to ask questions and be more knowledgeable about this part of their health. One of the top recommendations to older adults and family healthcare providers is always to request a copy of their laboratory results and then keep it in their file. This makes it easier to reference this useful information if you ever have questions about your health, or you need to see a different doctor.

So, we would list and explain the blood tests that are most commonly used for the medical care of older adults. We would round it up with some practical tips for you to keep in mind as regards blood test.

There are 4 common panels in laboratory blood testing. They include:

1. Complete blood count (CBC) – A CBC is a collection of the cells-related test in your blood. The following results are usually recommended:

• White blood cell count (WBC): this is the number of white blood cells per microliter of blood
• Red blood cell count (RBC): this is the number of red blood cells per microliter of blood
• Haemoglobin (Hyb): the number of oxygen-carrying protein for each deciliter of blood
• Hematocrit (HCT): the fraction of blood that is made up of red blood cells
• Mean Corpuscular Volume (MCV): This is the size of red blood cells on an average
• Platelet count (plts): The number of platelets (smaller cells involved in clotting blood) per microliter of blood

CBC testing can also be ordered ‘with differential’. This implies that the white blood cells are classified into their sub-types.

CBC is often used for:

• Diagnosis of anaemia (if the red blood cell count, haemoglobin, and hematocrit are lower than normal)
• The WBC count usually increases when a person is fighting an infection. Some medications like corticosteroids can trigger an increase in the white blood cell count
• If several types of blood cells like red blood cells, white blood cells, and platelets are low, this could be a sign of bone marrow problem
• An older person’s platelet count may occasionally be higher or lower than normal. This usually requires further evaluation

2. Basic Metabolic Panel (basic electrolyte panel) – Requesting a measurement of a single electrolyte is possible but, it is very common for the electrolyte to be ordered as part of 7 or 8 measurements. This is often referred to as ‘chem-7’, and it includes:

• Sodium
• Chloride
• Potassium
• Carbon dioxide: 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 (usually associated with an estimated glomerular filtration rate or an ‘eGFR’ result
• Glucose

The primary metabolic panel is often used for:

• Medication side effects can be the reason for electrolytes such as potassium or sodium to be either very low or very high – These electrolytes are often checked when people take certain types of medications like diuretics or certain blood medications.
• Calcium dioxide levels reflect the acidity of the blood – This can be affected by kidney function and by lung function. Acid levels in the blood can be changed by severe infection.
• Kidney function are commonly monitored by creatinine and BUN levels.. These two measurements increase if the kidney is temporarily impaired (e.g. by dehydration or a medication side-effect) or chronically impaired. Older adults are found to have at least mild decreases in kidney function. There must be different doses of many medications if a person has decreased kidney function. Labs now routinely use the patient’s age and creatinine level to evaluate an “estimated glomerular filtration rate,” which represents the kidney’s filtering power. This is seen as a better measure of kidney functioning than depending upon the levels of BUN and creatinine.
• The sugar quantity in the blood is represented by glucose levels. If they exceed the usual, this could be because diabetes has been diagnosed or inadequately controlled. Low glucose levelis called hypoglycemia; often caused by diabetes medications, and maybe a sign to reduce the dosage of these drugs.

3. Comprehensive Metabolic Panel – This panel includes the items mentioned in the basic metabolic panel, plus an additional seven items. For this reason, it’s sometimes known as a “Chem-14” panel. Beyond the seven tests included in the basic panel, the comprehensive panel also adds:

• Calcium
• Total protein
• Albumin
• Bilirubin (total)
• Alkaline phosphatase
• AST (aspartate aminotransferase)
• ALT (alanine aminotransferase)

The comprehensive metabolic panel is often used for:

• Calcium levels are usually controlled by the kidneys and certain hormones. The blood calcium level is ideal for assessing calcium intake or total calcium stores in the bones and body. When the levels of blood calcium are high or low, it can lead to symptoms like cognitive dysfunction, and usually pinpoints an underlying health problem. Certain types of medication can also cause them.
• One of the vital proteins in the bloodstream is Albumin. It is synthesised by the liver. Low albumin levels may be a sign of a problem with the liver or maintaining albumin in the bloodstream. Low albumin levels can be caused by malnutrition.
• AST and ALT are enzymes found in liver cells. Any increase in these enzymes often signfies a health problem affecting the liver. This can be caused by medications or by several other health conditions.
• The liver produces Bilirubin. It usually drains down the bile ducts and into the small intestine. The breakdown of red blood cells is related to some bilirubin. Gallstones can increase some bilirubin. It can also be increased by other issues blocking the bile ducts.
• Alkaline phosphatase is found all over the body, but commonly in bile ducts and also in the bone. A blockage in the liver or a problem affecting bone metabolism often leads to an increase in alkaline phosphatase.

4. Lipid (Cholesterol) Panel

These tests are used to measure the various types of fats and cholesterol in the bloodstream. The panel usually includes:

• Triglycerides
• High-density lipoprotein (HDL) cholesterol, sometimes known as “good” cholesterol
• Total cholesterol
• Low-density lipoprotein (LDL) cholesterol, often known as “bad” cholesterol. Before checking cholesterol levels, people are sometimes asked to fast. The reason is that triglycerides can increase after eating, and this could bring about a falsely low LDL calculation. In spite of this, experts have recently concluded that in most cases, fasting is not necessary; it is inconvenient, and the difference in test results is minimal.

Lipid panel is often used for:

• Evaluating cardiovascular risk in older adults.
• Total that is higher than normal or LDL cholesterol levels are sometimes treated with medications like statin. Changes in diet can also reduce them.

Other blood tests that are often ordered for older patients are:

1. Tests Related to Thyroid Function

These tests can be used to diagnose thyroid disorders. They also help to adjustwith the medication dosage of thyroid replacement.  The most common tests are:

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

 Other tests at blood testing clinic in London related to thyroid function may also be ordered in cases of complications.

What these recommend blood tests are often used for include the following:

• Older adults, especially older women, are commonly infected with thyroid problems. This problem is associated with symptoms such as fatigue and cognitive difficulties.
• Checking the TSH level is the first thing to do Ifsymptoms related to thyroid problems are observed in an older person.
• TSH usually shows the determination of body to whether the thyroid hormone available is sufficient. If the thyroid gland doesn’t produce enough thyroid hormone, TSH should be higher than normal. In the case of an abnormal TSH,  a free T4 is often used to confirm a thyroid hormone problem.

2. Tests Related to Vitamin B12 Levels

These tests measure the serum levels of vitamin B12 and give information that shows if the level is adequate for the body’s needs.  The two recommend blood tests involved in this procedure are:

• Vitamin B12
• Methylmalonic acid

Depending on the condition, if an older adult has low vitamin B12 levels, additional testing may be needed to specify the underlying cause of this vitamin deficiency.

These tests are often used for:

• A deficiency of Vitamin B12 is quite common in older adults and can be associated with common problems like walking difficulties, fatigue, and memory problems.
• The level of methylmalonic acid in the body is related to vitamin B12 level and can diagnose a vitamin B12 deficiency. It is very crucial to check this if an older person has vitamin B12 levels that are abnormally low. Low vitamin B12 levels are related to higher-than-normal methylmalonic acid levels

For more information, visit our blood testing clinic in London.

3. GlycatedHaemoglobin (Haemoglobin A1C)

When blood glucose attaches to the haemoglobin in red blood cells, glycatedhaemoglobin is formed. This is normal, but if you have an abnormal level of glucose in the blood, then your percentage of glycatedhaemoglobin will be higher than normal. The higher your average blood sugar level, the greater your percentage of glycatedhaemoglobin. A result of 6.5% or above indicates diabetes. For more information, conduct a haemoglobin A1C test at our blood testing clinic in London.

This test is usually used for:

• Monitoring the blood sugar level of people with diabetes. A blood glucose level) shows the blood glucose level at a specific moment in time, but a haemoglobin A1C reflects how high a person’s blood sugar has been, on average, over the prior three months.
• Haemoglobin A1C test can also be used as part of a diagnostic test for possible pre-diabetes or diabetes.

We recommend that older adults should work with their doctors to determine what A1C goal is right for them. It’s often ideal to aim for a slightly higher goal in older adults than in younger adults.

4. International Normalized Ratio (INR) and Prothrombin Time (PT)

Both tests are used to measure the rate of a person’s blood clots. People taking warfarin (brand name Coumadin) which is a blood-thinner must have this regularly monitored.

What this test is usually used for:

• The prothrombin time is used to calculate the INR in the laboratory. For people on warfarin, they aim for their INR to be between 2.0 and 3.0. A primary reason why older adults take warfarin is to avoid atrial fibrillation strokes. Warfarin may be recommended if an individual experiences a blood clot in the lungs, legsor elsewhere.
• The prothrombin time is often checked if there are issues on severe infection abnormal bleeding, or the liver’s ability to synthesise clotting factors.

5. Brain Natriuretic Peptide (BNP) Test

Although the name seems brain-related, BNP levels will be checked as they relate to heart functioning (not brain function!). When an individual’s heart fails to pump blood effectively, BNP levels rise; causing a problem known as “heart failure.”

A similar, but less commonly used test is the “N-terminal pro-B-type natriuretic peptide” (NT-proBNP) test.

Uses of this test are:

• For evaluating heart failure in their early stage or worsened state. This chronic condition is common among older adults, and it can occasionally get worse.
• The BNP test can be ideal for checking out a person who is experiencing shortness of breath. Breath shortage can be caused by a plethora of problems, including pneumonia, chronic obstructive pulmonary disease, pulmonary oedema, angina, etc. A low BNP level implies that at that instant, the shortness of breath may not be due to heart failure.
• A regular evaluation of BNP levels is also sometimes used to monitor a person’s heart failure and response to treatment.

For more about heart failure, visit our blood testing clinic in London.

6. Ferritin

The body’s serum ferritin level is linked to the stores of iron in the body. For more about this test:

• Ferritin – Depending on the condition, if an older person’s iron levels require further evaluation, additional tests may be necessary.

 This test is used for:

• Ferritin levels are most commonly employed as part of a diagnosis for anaemia (low red blood cell count). A low ferritin level may be a sign of iron-deficiency, which is a common cause of anaemia. Studies estimate that only a third of anaemia in older adults are caused by deficiencies in iron or other essential elements. It is vital to check iron deficiency by uing ferritin and series of other tests for treatment of older people’sanaemia.
• Another thing that influences the ferritin level is inflammation. It tends to make ferritin levels increase.
• If it is found that there are other reasons to be concerned about an older person’s ability to manage iron, additional blood tests related to iron may be done.

Several other tests can be ordered as part of the medical care of older adults. But the tests covered above are, by far, the ones that are ordered the most often.

Below are some helpful tips that will help you benefit from your blood tests and results

Here are our top tips:

1. Ensure you understand the reason a given test is being ordered. Questons like the reason for evaluating a symptom or monitor a chronic condition should be known. Assess whether a treatment is effective.

You will get to comprehend your health issues better if you ask questions about the purpose of the blood tests your doctors are proposing.

In general, we recommend bloodtestsonly when there is a cogent reason, mostly to evaluate a concerning symptom, to monitor chronic disease, or to diagnose for certain types of medication side-effect.

Bear in mind that it’s only occasionally ideal to order blood tests for “screening.” A screening test means you have no symptoms. Such types of screening blood tests will be recommended only for just a few conditions.

To get more information on preventive health care and screening tests that may be appropriate for older adults, do book an appointment with us.

2. Ask your doctor for a review and explanation of the results as it relates to your health. Discuss the result with your doctor. It’s very important to ask about any result that is termed ‘abnormal’ by the laboratory.

For instance, there are cases where many older adults are unaware of the fact that they have mild or moderate kidney problems, even though this has been shown in previous laboratory tests. This occurs when people fail to review reports and ask enough questions.

Have you ever wondered why it rarely told to older people by the doctor 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 not get around to mentioning a mild abnormality that is pretty common in older people, such asmild kidney dysfunctionormildanaemia.

3. Ask your doctor to explain how your results compare with your previous results. It is the norm for laboratory reports to come with a reference range. A very vital part is to see how a given result compares to your previous results.

For instance, if the complete blood count (CBC) of older person shows signs of anaemia, it’s very good to consider previous CBC results. This would help to ascertain the blood count’s course. A blood count which drifts down or dropping all of a sudden is more disturbing than the one that has lower-than-normal, but stable for the past year.

Indeed, you will want to understand what might be the cause of an abnormal result regardless of the trajectory. But having a worse result for your blood test denotes the problem is critical to sort out.

4. Ask for copies of your results, and save them for record purpose. The laboratory results provide necessary information to the health providers and can be very useful to you as well. Most times it is demanded during diagnosis of a new infection or disease.

If you keep your result copies, you’ll be 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 to better understand it and know what questions to ask your doctor.

For instance, a patient recently had a “routine” cholesterol panel done. She takes no medications, is quite fit, and is in good health, so she was surprised when some of her results came back higher than normal. We promptly reviewed her previous results, from three years ago, and found that those results were within the normal range. So this patient is now in the process of changing her diet.

What would have happened?If she hadn’t had copies of her previous labs? Well, maybe she could have asked her doctor,  but it is safer and more convenient to have your records!

Pleas, we advise that you don’t rely strictly on past results from patient’s portal. Clinics will often remove your access if you are deemed to have left the practice.  So, you can see why personal record keeping is essential.

For more on the benefits of maintaining your health record or that of an older person, do visit our blood testing clinic in London for proper care and advice.

If you have questions about recomended blood tests for older adults, we run a blood testing clinic in London. Feel free to walk in anytime.

We have good doctors and nurses that are friendly, knowledgeable and smart. You are always welcomed to unburden any health issue you have and be rest assured that our treatment and diagnosis will go a long way to restore your health. Please remember, age comes with some common health concerns. We’re here for that concern!