Last year we changed our amylase method to fall in line with the rest of the
West of Scotland and circulated the clinical staff announcing the new upper
limit of normal at 100 U/L
One of the surgeons asked what the new level for cut-off for pancreatitis
would be - unknown to us, they had been using 1000 previously.
Dredging the memory banks, we recalled someone at Glasgow Western Infirmary
had come up with this figure about 25 years ago when the upper limit was,
from memory, 300 When we moved from the Phadebas manual method to an
automated method, the upper limit fell to 250, which is probably when the "4
times" came into folk lore.
Or does someone know of it being "evidence based"?
-----Original Message-----
From: p=NHS NATIONAL INT;a=NHS;c=GB;dda:RFC-822=acb-clin-chem-gen-requ
Sent: 25 July 2000 18:46
To: p=NHS NATIONAL INT;a=NHS;c=GB;dda:RFC-822=ACB-CLIN-CHEM-GEN(a)ma
Subject: LIPASE
Dear All,
We had a request for serum lipase on an ITU patient "..because his amylase
is only 16U/L and he's got very bad abdo. pain." On enquiring who was
requesting this I was told that "someone" had been reading the UK guidelines
for the management of acute pancreatitis (Gut 1998, 42, suppl. 2: S1-S13).
While not wishing to convey the idea that my reading may be a little behind,
has anyone else read these (recently) ? It says "..Amylase activity is
usually 4x ULN or more".. and "..although less frequently available a serum
lipase measurement is diagnostically accurate. The advantages of measuring
lipase are that its activity remains increased for longer than that of serum
amylase and that there are no other sources of lipase to reach serum and
thus this test has high specificity ." Does anyone else use lipase rather
than amylase ? or have we been by-passed by go-ahead gastrenterologists ?
More to the point, is anyone using an autoanalyser-friendly method ?
Thanks,
Philip Hyde,
Pilgrim Hospital,
Boston (UK).
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