Also any comment on the correlation (or the lack of it) between ALP and
either 1,25-vitamin D or phosphate in these children would be greatly
appreciated. Please take the following anecdote only as an indication of
the unfortunate prevalence of the problem in some communities. When an
eminent bone physician in the Midlands was asked many years ago how he
screened his young patients for osteomalacia, he replied that he would
first ask them to stand up and introduce themselves. If the child stood up
effortlessly and gave his name as John Smith, he probably didn't have any
problem. If, on the other hand, he had to use the arms of the chair to
help himself up and his name suggested a foreign descent, the likelihood
was that he probably had rickets and needed further investigation. The
problem is well-recognised in some Middle-Eastern and Asian countries (even
though not much has been done about it). Evidence from the literature here
also seems to suggest a large number of mild but undiagnosed cases, to the
extent that some authors have even gone as far as to suggest in their
conclusions a need for general screening. This leads to the important
question posed by Eric as to what screening test may be most effective.
Best wishes,
Reza
At 11:01 03/09/03, Eric Hindle wrote:
>A Consultant Paediatrician colleague has just told me that she doesn't
>believe our alkaline phosphatase results, as she almost never sees a raised
>level in children with suspected vitamin D and calcium deficiency (causing
>rickets) subsequently demonstrated by lowish calcium and vitamin D levels
>and raised PTH, as well as other clinical and radiological signs.
>
>Our internal and external QC performace is exemplary and we will be
>reviewing our data to see if she is correct in her conclusion (and if she
>is we will stop doing them and save some money!).
>
>Any suggestions why we might not be seeing expected elevations in AP or is
>this something I should have known about?
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
---
Outgoing mail is certified Virus Free.
Checked by AVG anti-virus system (http://www.grisoft.com).
Version: 6.0.507 / Virus Database: 304 - Release Date: 04/08/03
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|