The problem with requesting other tests in patients like this is that the GP
will not have informed you that the patient is on ripoffopril [or other ACE
inhbitor], expensivosartan etc. Prils and sartans frequently cause liver
anomalies and are very frequently used drugs, so you are probably chasing
phantoms.
We only request caeruloplasmin and AAT if a physician has specifically asked
for it [of course we run the risk we may not find something very rare - but
if we didn't, we know for certain our finance director would be heading our
direction as he always complains about our overspend (his words) /
underfinancing (our words).
TIM
****************************************************************************
*********
Prof. Tim Reynolds,
Clinical Chemistry Department,
Queens Hospital,
Belvedere Rd.,
Burton-on-Trent,
STAFFORDSHIRE,
DE13 0RB,
UK.
tel: 01283 511511 ext. 4035
fax: 01283 593064
email: [log in to unmask]
alternative email for the all too frequent occasions when the NHS email
connection doesn't work:
[log in to unmask]
****************************************************************************
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> -----Original Message-----
> From: Anne Tarn [mailto:[log in to unmask]]
> Sent: 14 July 2003 14:27
> To: [log in to unmask]
> Subject: Investigation of patients with abnormal liver enzymes
>
>
> Dear Mailbase participants,
>
> I'd be very grateful for the help of this forum. We are currently
> 'discussing' (read what you like into the quotation marks!)
> the usefulness
> of requesting alpha-1-antitrypsin and caeruloplasmin in patients with
> asymptomatic abnormalities of liver enzymes . Othe tests in
> the 'screen'
> include ferritin, hepatitis serology, AFP, AutoAb, liver USS,
> often tumour
> markers, Igs, protein EPS.
>
> We have agreed that caeruloplasmin is unlikely to be useful
> in those over
> 50 (perhaps we should drop this to 40 given the NEJM paper by
> Pratt and
> Kaplan 2000; 342: 1266-1271). We run into difficulties over
> the following:
> how abnormal is abnormal?
> should these investigations be done if only the YGT is raised?
> AAT concentration vs. phenotype - we currently only offer
> concentration and
> could not sustain the numbers if all went for phenotying (372
> last year -
> all normal) - most have an electrophoretic strip done as well
> ? usefulness if known other diagnosis to explain abnormal
> enzymes - hep B,
> C, ETOH.
>
> I'd be interested to know how others approach this and if
> there are any
> published guidelines. I will happily collate the responses
> for the mailbase
> and send apologies if this has been discussed before.
>
>
> Anne Tarn
>
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