I agree, in general with what Elizabeth Mac Namara is
saying, the medic ordering the test is the one in
charge and discussing the reason for added tests with
him is much more productive, in terms of laboratory
services, than refusing to do a test. (or don't we do
that any more?). Mohammad Al-jubouri said he has
criteria for adding tests......
A high blood sugar first time - add HbA1c
- Hypercalacaemia (sic) - add PTH
- Hypocalcaemia - add PTH, magnesium
-FSH < 0.1, high oestradiol - add Beta hCG
-unexplained metabolic acisosis (sic) - measure anion
gap and osmolal gaps
-Unexplained hypokalaemia - add magnesium
-Hyponatraemia - add osmolality, and somtimes TSH and
cortisol
-isolated rise AST/ALT- add CK
-High fasting triglycerdies - add blood sugar
-low alpha 1 antitrypsin - add phenotyping.
I realise in this day and age we are highly
computerised with up to date patient databases, but
how do you know if it is a first time high glucose or
low calcium, and are we sure it was a fasting sample
for that high triglycerides?. Unexplained
hypokalaemia? why? because there was nothing to
suggest it on the request form. We all know that
request forms and reasons for requests are inadequate,
therefore I believe that in general adding tests is a
bit like trying to outguess the requesting medic.
David Brown
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