Complete Blood Count (CBC) without Differential, Blood (LAB294), Basic Metabolic Panel (BMP) (LAB15), Comprehensive Metabolic Panel (CMP) (LAB17)

Daily CBC and chemistry panels may not be useful in clinically stable hospitalized patients without specific indications.

Clinical Background
  • Repeat daily complete blood count (CBC) and/or basic chemistry panels (BMP or CMP) in clinically stable patients are unlikely to provide actionable information (1).
  • Unwarranted repetitive peripheral blood testing exposes patients to unnecessary phlebotomy that causes patient discomfort and may lead to iatrogenic or hospital-acquired anemia with possible increased blood transfusions.  This can contribute to poor patient outcomes by increasing the 30-day re-admission rates, the length of patient stays, and overall patient morbidity and mortality (2). Unnecessary laboratory tests also consume substantial hospital resources and personnel time (both in patient care areas and in hospital laboratories).
  • As a result, multiple professional societies, including the Society for Hospital Medicine (SHM) and the Association for the Advancement of Blood and Biotherapies (AABB) recommend against repeat testing for clinically stable patients (3,4).
Common Pitfalls
  • CBC and basic chemistry panels are frequently ordered as repeated daily labs for stable hospitalized patients without an indication or a specific endpoint.
Key Takeaways
  • Daily repeat of CBC and/or basic chemistry testing in stable patients without indication is unnecessary, wasteful, can cause anemia, and is discouraged.
  • A better practice is to order specific tests as needed until clinical stability is achieved, then discontinue ordering them.
  • Regularly review and verify patient lab orders are appropriate and discontinue repeating labs if they are no longer clinically useful.
References
  1. Xu S, Hom J, Balasubramanian S, et al. Prevalence and Predictability of Low-Yield Inpatient Laboratory Diagnostic Tests. JAMA Netw Open. 2019;2(9):e1910967.
  2. Koch CG, Li L, Sun Z, Hixson ED, Tang A, Phillips SC, Blackstone EH, Henderson JM. Hospital-acquired anemia: prevalence, outcomes, and healthcare implications. J Hosp Med. 2013 Sep;8(9):506-12.
  3. Bulger, J., Nickel, W., Messler, J., Goldstein, J., O’Callaghan, J., Auron, M. and Gulati, M. (2013), Choosing wisely in adult hospital medicine: Five opportunities for improved healthcare value. J. Hosp. Med., 8: 486-492.
  4. Callum, J.L., Waters, J.H., Shaz, B.H., Sloan, S.R. and Murphy, M.F. (2014), AABB CHOOSING WISELY CAMPAIGN. Transfusion, 54: 2344-2352.

Written By: Vahid Azimi, MD

Reviewed By: Yang Cao, PhD and Cara Lunn Shirai, PhD

Last Edited: 2024-09-15

Last Reviewed: 2024-09-15