You may be surprised to learn what the großes Blutbild actually tests, what it leaves out, what the German healthcare system covers, and what a genuinely insightful blood panel looks like.
In 2015, the Robert Koch Institut published the results of DEGS1, the deepest health survey of adults in Germany to date. Among its findings: 61.6% of German adults had vitamin D levels below the threshold of 50 nmol/L. During winter, the proportion with adequate vitamin D status fell to just 17.6%. The data covered nearly 7,000 participants across every age group, latitude, and socioeconomic tier. Vitamin D deficiency, the researchers concluded, is “still common among adults in Germany.”
The same year, a meta-analysis published in the British Journal of Nutrition examined six randomised controlled trials on iron supplementation in people with iron deficiency but without anaemia. The trials consistently showed that iron treatment reduced fatigue, with a pooled effect size that was both statistically and clinically significant. The catch: these patients had all been told their blood work was “normal.” Their haemoglobin was fine. Their full blood count showed nothing unusual. But their ferritin, the marker that measures actual iron stores, was depleted. And nobody had tested it.
This is the paradox at the centre of preventive blood testing in Germany. The test most people think of as thorough, the großes Blutbild, does not measure vitamin D. It does not measure ferritin. It does not measure thyroid function, cholesterol, blood sugar, liver enzymes, kidney markers, hormones, or inflammation. It counts your blood cells. That is valuable for diagnosing certain conditions. But it tells you almost nothing about the metabolic, nutritional, and hormonal health that actually determines how you feel, how you perform, and how you age.
The name suggests something vast. In clinical reality, a großes Blutbild is a kleines Blutbild (small blood count) combined with a Differentialblutbild (differential white blood cell count). The word “groß” does not mean “thorough.” It means the laboratory also breaks down the subtypes of your white blood cells. As the München Klinik explains in its clinical reference:
“Beim großen Blutbild werden neben dem kleinen Blutbild nur noch die weißen Blutkörperchen nach ihren verschiedenen Zelltypen differenziert. Cholesterin, Entzündungsmarker oder Hormone werden also auch nicht im großen Blutbild bestimmt, wie viele meinen.”
Erythrocytes (red blood cells), leukocytes (white blood cells, total count), thrombocytes (platelets), haemoglobin (Hb), haematocrit (Hkt), MCV (mean corpuscular volume), MCH (mean corpuscular haemoglobin), MCHC (mean corpuscular haemoglobin concentration).
Neutrophil granulocytes, eosinophil granulocytes, basophil granulocytes, lymphocytes, monocytes.
That is the entire test. Roughly 15-18 parameters, all related to blood cell counts, sizes, and proportions. Clinically, the großes Blutbild is useful for investigating anaemia, acute or chronic infections, allergic reactions, immune disorders, blood cancers, and clotting abnormalities. For a doctor pursuing a specific diagnostic question, it is a valuable tool.
But it is not a complete health check. The distinction matters.
Bioscientia, one of Germany’s largest laboratory diagnostics companies, states it plainly on their own clinical information page: “Das große Blutbild umfasst keine spezifischen Tests für Organfunktionen, wie zum Beispiel Leberwerte, Nierenwerte und Schilddrüsenwerte. Auch die ausreichende Versorgung mit Vitaminen und Nährstoffen wird nicht in einem großen Blutbild untersucht.” Here is the full scope of what is absent:
Look at that table again. Cholesterol. Blood sugar. Thyroid. Iron stores. Vitamin D. Liver and kidney function. Inflammation markers. Hormones. These are the markers that drive the conditions most Germans are genuinely worried about: heart disease, diabetes, fatigue, thyroid dysfunction, nutrient deficiencies, hormonal imbalance. None of them appear in the großes Blutbild.
Tumour markers, too, are frequently assumed to be included. They are not. Bioscientia confirms:
“Tumormarker ... sind kein Bestandteil eines standardmäßigen großen Blutbildes.” If your goal is cancer screening through blood work, the großes Blutbild is not the test that delivers it.
Germany’s statutory health insurance system entitles every adult to a Gesundheits-Check-up: once between ages 18-34, then every three years from age 35 onward. The blood work included in this check-up is defined by the Gemeinsamer Bundesausschuss (G-BA), the federal body that determines which services the gesetzliche Krankenversicherung covers.
That is the entire blood panel from the Check-up 35: four lipid values and a blood sugar reading. No thyroid. No iron. No vitamin D. No liver enzymes. No kidney markers. No inflammation. No hormones. Five values, tested once every three years.
Your Hausarzt can request additional blood work, including a großes Blutbild, when there is a medical indication: a specific symptom, a suspected condition, or a known disease requiring monitoring. The Krankenkasse covers that cost. But the operative phrase is “medizinische Indikation.” The system is designed around responding to disease, not around proactive screening for people who feel well but want to understand their health before something goes wrong.
Without a medical indication, a großes Blutbild ordered privately typically costs around €25-40. But since the großes Blutbild only tests blood cells, most people asking their GP for a “thorough blood test” want additional parameters: liver, kidney, thyroid, iron, vitamins. Each additional panel adds cost.
A reasonably broad set of extras can easily reach €100-250 or more, depending on how many markers your doctor selects. And the interpretation you receive is typically a printout of values with laboratory reference ranges, reviewed in a brief follow-up conversation.
This is not a criticism of German GPs. The problem is systemic, and it affects every patient who walks in wanting a comprehensive health picture.
The average GP consultation in Germany runs roughly 7-8 minutes. That is not enough time to take a detailed history, decide on an appropriate panel of 30-50 biomarkers, explain what each one measures, and later interpret the results in context. In practice, GPs order what they need for a specific clinical question. They are not incentivised, and the Kassensystem does not support, a broad preventive panel for someone who says “I just want to know how I’m doing.”
When results come back, they arrive with laboratory reference ranges: the middle 95% of the general population. If your value falls within that range, you will typically hear “alles in Ordnung.” But “normal” and “optimal” are not the same thing. A ferritin of 18 µg/L sits inside many lab reference ranges. But a landmark study by Dr. Erkki Soppi, published in Clinical Case Reports (2018), documented patients with ferritin values in this “normal” range suffering from years of fatigue, brain fog, and restless legs, all of which resolved entirely when ferritin was raised above 100 µg/L, with no change whatsoever in their haemoglobin. The großes Blutbild would have shown nothing wrong.
Perhaps the most significant gap: individual values mean more when read together. Ferritin interacts with CRP (inflammation raises ferritin, masking true iron deficiency). A “normal” TSH can coexist with early autoimmune thyroiditis if antibodies are not tested. Fasting glucose alone misses insulin resistance that HbA1c and fasting insulin would catch years earlier. This kind of multi-marker interpretation requires time and a framework built for it, neither of which the standard GP model provides.
If what you want is a real picture of your health, here is what the evidence says matters, and what comprehensive testing actually includes.
Metabolic health: Fasting glucose, HbA1c, fasting insulin, HOMA-IR. Insulin resistance, the metabolic dysfunction that precedes type 2 diabetes by 5-15 years, shows up in fasting insulin and HOMA-IR long before a glucose reading would flag anything. Testing only glucose catches diabetes that has already arrived. Testing the full panel catches it at the stage where lifestyle changes are most effective.
Cardiovascular risk: Full lipid panel (total cholesterol, LDL, HDL, triglycerides) plus Lp(a), ApoB, and homocysteine. The 2021 ESC Guidelines on cardiovascular disease prevention recommend Lp(a) testing at least once in every adult’s lifetime, since elevated Lp(a) is a genetic risk factor present in roughly 20% of Europeans, and most have never been tested. The Check-up 35 covers basic lipids. It does not cover Lp(a), ApoB, or homocysteine.
Thyroid function: TSH, free T4, free T3, and thyroid antibodies (TPO-Ab, Tg-Ab). A meta-analysis by Mendes et al. (2019) estimated undiagnosed hypothyroidism at 4.7% across European populations, predominantly the subclinical form. Fatigue, weight gain, cold sensitivity, and brain fog are classic symptoms. TSH alone catches many cases, but it misses impaired T4-to-T3 conversion and early Hashimoto’s thyroiditis, which requires antibody testing to detect.
Iron status: Ferritin, serum iron, transferrin saturation. Iron deficiency without anaemia (IDWA) is, according to a 2021 review published in the Internal Medicine Journal, “at least twice as common” as iron deficiency anaemia. A systematic review of RCTs confirmed that iron supplementation reduces self-reported fatigue in non-anaemic individuals with low ferritin. Yet ferritin is not part of the großes Blutbild. Your haemoglobin can look perfectly fine while your iron stores are depleted. (More on iron and energy biomarkers here.)
Vitamins and nutrients: Vitamin D, B12, folate, magnesium, zinc, selenium. The DEGS1 survey found that 61.6% of German adults had vitamin D below 50 nmol/L, with winter adequacy rates falling to 17.6%. Vitamin B12 deficiency affects an estimated 10-15% of adults over 60, with risk elevated in vegetarians, vegans, and anyone on long-term PPI or metformin use. (Our article on vitamin D in Northern Europe explores this in depth.)
Inflammation: hs-CRP (high-sensitivity C-reactive protein). The landmark JUPITER trial, published in the New England Journal of Medicine, demonstrated that elevated hs-CRP predicts cardiovascular events independently of cholesterol. Low-grade chronic inflammation is invisible without testing, and it is one of the most valuable and inexpensive preventive markers available.
Liver and kidney function: GOT, GPT, GGT, creatinine, GFR, uric acid. Fatty liver disease, for instance, is estimated to affect 20-30% of adults in Western countries and is often asymptomatic until advanced stages. Liver enzymes catch it early.
Hormones: Testosterone, cortisol, DHEA-S, SHBG. Hormonal balance affects energy, mood, body composition, sleep, and long-term disease risk. These markers are virtually never tested in routine GP blood work.
Blood count: Yes, the full großes Blutbild is included too, as one component of the overall panel, not as the whole test.
Aniva’s biomarker panel was built to cover all of this: 100+ biomarkers from a single venous blood draw, tested at an ISO 15189-certified German laboratory, with results interpreted in context and delivered as a personalised report with actionable recommendations.
Cost is understandably the first practical question. Here is how the options compare:
At €199 per year, Aniva’s annual membership costs roughly the same as a single extended GP visit but covers vastly more ground and includes the contextualised interpretation that makes the numbers meaningful. It complements, rather than replaces, your Krankenkasse entitlements. (See how the testing process works.)
If you are reading this because you feel tired, run down, or “not right” and want to understand why, here are the markers with the strongest evidence for explaining medically addressable symptoms, none of which appear in the großes Blutbild.
Iron deficiency is the most common nutritional deficiency worldwide, affecting up to 25% of the global population. In a 2024 study published in BMC Hematology, researchers at an iron deficiency clinic found that eight out of ten patients with non-anaemic iron deficiency reported weakness, fatigue, and easy fatigability, along with a striking average of 16.5 distinct symptoms per patient, ranging from memory problems to cold intolerance to hair loss. All of these patients had “normal” blood counts. A großes Blutbild would have shown nothing wrong. The only marker that caught the deficiency was ferritin. A French RCT by Vaucher et al. (2012) found that iron supplementation reduced fatigue by nearly 50% in non-anaemic women with ferritin below 50 µg/L. (More on iron and energy biomarkers.)
Roughly 4-5% of Europeans have undiagnosed hypothyroidism, predominantly the subclinical form where TSH is mildly elevated but thyroid hormone levels remain in the reference range. Fatigue, weight gain, cold sensitivity, and cognitive fog are hallmark symptoms. The großes Blutbild does not include TSH or any thyroid marker. Even when GPs do test thyroid function, they typically order only TSH, missing impaired T4-to-T3 conversion and early autoimmune thyroiditis, which requires TPO antibody testing to detect. Antibodies can be elevated years before TSH rises.
The DEGS1 data speaks for itself: during winter, only 17.6% of German adults have adequate vitamin D levels. Even during summer, barely half reach the 50 nmol/L threshold. The seasonal gradient is stark: a significant south-to-north decline was observed, consistent with Germany’s latitude between 47° and 55° North. Deficiency is linked to impaired immune function, bone health, fatigue, and mood disorders. It is a simple, inexpensive test, yet it is not part of any routine screening in Germany. (Our article on vitamin D in Northern Europe.)
High-sensitivity C-reactive protein measures low-grade systemic inflammation, a driver of cardiovascular disease, metabolic dysfunction, and accelerated biological ageing. The JUPITER trial showed that elevated hs-CRP predicts cardiovascular events independently of cholesterol. A single blood draw. One of the most cost-effective preventive markers that exists. Not part of the großes Blutbild. Not part of the Check-up 35.
The Check-up 35 tests fasting glucose. This catches diabetes that has already arrived. But insulin resistance, the metabolic dysfunction that precedes diabetes by years, is visible in fasting insulin and HOMA-IR long before glucose starts to rise. HbA1c provides a three-month average of blood sugar regulation rather than a single-morning snapshot. Testing all three catches metabolic problems at the stage when they are still fully reversible through lifestyle changes. Testing only glucose catches them too late for many people.
You exercise regularly, eat reasonably well, sleep seven hours, and still feel persistently drained. Your GP checked standard blood work and said everything is fine. What they almost certainly did not test: ferritin, free T3, vitamin D, cortisol, fasting insulin. These are the markers that explain medically addressable fatigue in people whose standard blood work looks unremarkable.
Managing a career, possibly a family, definitely more stress than she would like. She buys organic food, tries to exercise, and is vaguely worried she is not doing enough. What she wants is clarity: not a vague reassurance but specific, actionable data about her iron stores, thyroid function, hormonal balance, and metabolic trajectory. Comprehensive testing gives her the answer.
Not sick. Not particularly anxious. But interested in performing at their best and catching problems before they start. This person does not need a doctor to tell them something is wrong. They need data to show where they stand and what they can improve. The großes Blutbild was never designed for this person, because it is a diagnostic tool, not a preventive one.
The Gesundheits-Check-up is better than nothing. Five values every three years is a starting point. But if you understand that most chronic diseases develop silently over years before symptoms appear, five values every three years does not provide the resolution to catch what matters early.
You can, and for many people that works. But there are practical limitations worth knowing.
Most GPs order what is clinically indicated for a presenting complaint. Few will proactively order ferritin, vitamin D, hs-CRP, homocysteine, Lp(a), fasting insulin, DHEA-S, and a full thyroid panel with antibodies for a seemingly healthy 32-year-old requesting a general check. Not because these markers lack value, but because the consultation model does not support it.
Interpretation is typically brief: values within the reference range are reported as normal, values outside get flagged. What you generally do not receive is the contextualised reading: how your ferritin relates to your CRP, what fasting insulin means alongside HbA1c, whether thyroid antibodies suggest early autoimmune disease despite a still-normal TSH.
And preventive health is not a single test but a trajectory. A ferritin reading has limited value in isolation. The same reading compared to six months ago, after specific changes to your diet, supplements, or training, tells you whether your intervention is working. Most GP practices are not set up for this kind of longitudinal preventive tracking. That is exactly what a dedicated service like Aniva is built for: baseline, personalised action plan, follow-up, iteration. (How Aniva ensures quality and process integrity.)
Start with your Hausarzt. Fatigue, pain, digestive issues, unexplained weight changes: your GP is the right first step. They can order targeted blood work based on your symptoms, and the Krankenkasse covers it. The großes Blutbild may well be part of that workup.
Use your Check-up 35 entitlement. If you are over 35, book it every three years. It is free, straightforward, and the lipid and glucose screening is a useful baseline, even if limited.
This is where a dedicated comprehensive panel adds the most value. Not instead of your GP, but alongside them. You use the Check-up 35 for what it covers. You see your Hausarzt when symptoms arise. And you supplement both with an annual comprehensive panel that tests the markers neither the Check-up 35 nor the großes Blutbild includes: iron, thyroid, vitamins, inflammation, hormones, metabolic risk, and more. (This is what Aniva’s approach to preventive health is built around: complementing the existing system, not replacing it.)
Apply for Aniva’s annual membership. 100+ biomarkers, tested at a certified German laboratory, with a personalised report and action plan, for €199 per year. It includes everything the großes Blutbild covers, everything the Check-up 35 covers, and the 80+ additional markers that neither of them touches. One blood draw. One comprehensive report. A clear, actionable picture of your health.
With a medical indication, your Krankenkasse covers it. Without one, it is an IGeL service costing roughly €25-40 for the blood cell analysis alone. Additional markers (liver, kidney, thyroid, vitamins) are separate and add cost.
Only indirectly. It may show low haemoglobin or small red blood cells (low MCV), which suggest iron deficiency. But it does not test ferritin, the direct measure of iron stores. Clinical research consistently shows that iron stores can be profoundly depleted, causing significant fatigue, while haemoglobin and the großes Blutbild remain completely normal.
No. CRP, hs-CRP, and ESR are separate tests not included in the großes Blutbild.
No. Tumour markers like PSA, CEA, and CA-125 are specialised tests ordered for specific clinical situations. They are not part of any standard Blutbild.
For its intended purpose (investigating infections, immune disorders, blood cell abnormalities), absolutely. But if your goal is a preventive health assessment, the großes Blutbild covers only a small fraction of what matters. The question is not whether it is worth it, but whether it is the right test for what you are trying to learn.
Home finger-prick kits exist but are limited in the volume of blood they collect and the markers they can test. A comprehensive panel requires a standard venous blood draw from the arm, which provides enough sample for 100+ markers from a single sitting.
The Check-up 35 provides screening every three years. For comprehensive preventive testing, most experts recommend an annual baseline. Annual testing lets you track trends, measure the impact of lifestyle changes, and catch emerging patterns. Aniva’s membership is structured around this annual cycle. (Learn how it works.)
1. Rabenberg M, et al. Vitamin D status among adults in Germany: results from the DEGS1 survey. BMC Public Health. 2015;15:641.
2. Hintzpeter B, et al. Vitamin D status and health correlates among German adults. European Journal of Clinical Nutrition. 2008;62:1079-1089.
3. Yokoi K, Konomi A. Iron deficiency without anaemia is a potential cause of fatigue: meta-analyses of RCTs and cross-sectional studies. British Journal of Nutrition. 2017;117(10):1422-1431.
4. Pasricha SR, et al. Iron deficiency without anaemia: a diagnosis that matters. Internal Medicine Journal. 2021;51(2):168-173.
5. Soppi ET. Iron deficiency without anemia: a clinical challenge. Clinical Case Reports. 2018;6(6):1082-1086.
6. Vaucher P, et al. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin. CMAJ. 2012;184(11):1247-1254.
7. Yilmaz M, et al. Beyond anemia: a comprehensive analysis of iron deficiency symptoms in women and their correlation with biomarkers. BMC Hematology. 2024.
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11. Bundesministerium für Gesundheit. Gesundheits-Check-up. bundesgesundheitsministerium.de. Accessed February 2026.
12. Gemeinsamer Bundesausschuss (G-BA). Gesundheitsuntersuchungs-Richtlinie. g-ba.de. Accessed February 2026.
13. Kassenärztliche Bundesvereinigung (KBV). Check-up: Informationen für Praxen. kbv.de. Accessed February 2026.
14. Bioscientia. Großes Blutbild: Blutwerte & ihre Bedeutung. bioscientia.de. Accessed February 2026.
15. München Klinik. Das kleine und große Blutbild. muenchen-klinik.de. Updated September 2023.
16. DocCheck Flexikon. Großes Blutbild. flexikon.doccheck.com. Last edited May 2024.
17. Cashman KD, et al. Vitamin D deficiency in Europe: pandemic? American Journal of Clinical Nutrition. 2016;103(4):1033-1044.
18. Camaschella C. Iron deficiency. Blood. 2019;133(1):30-39.
19. Quintana-Lopez L, et al. Iron deficiency without anemia: indications for treatment. GREM Journal. 2020;4.
20. Nordic Council of Ministers. Nordic Nutrition Recommendations 2023. Nord 2023:003.
21. Robert Koch Institut. Gesundheit in Deutschland aktuell (GEDA). rki.de.
22. Pludowski P, et al. Global prevalence of vitamin D deficiency: pooled analysis of 7.9 million participants. Frontiers in Nutrition. 2023;10:1070808.
→ The Complete Guide to Preventive Blood Testing in Europe
→ Vitamin D in Northern Europe: What the Data Says
→ Biological Age vs. Chronological Age
→ Partner & Process Integrity: How Aniva Ensures Quality
This article is for informational and educational purposes only. It is not intended as medical advice, diagnosis, or treatment. The information provided should not be used as a substitute for professional medical consultation. Blood test results should always be interpreted in the context of your individual health history, symptoms, and clinical picture by a qualified healthcare professional. Reference ranges, optimal ranges, and guidelines discussed in this article may not apply to all individuals and can change as new evidence emerges. If you have specific health concerns, please consult your doctor or a licensed medical practitioner. Aniva Health does not provide medical diagnoses or treatment recommendations.
