I've just solicited the opinion of a consultant Haematologist who holds the views that, with her laboratory-based practitioner hat on, total protein probably has no relevance in an LFT panel, but with a clinical practitioner hat on, the number of previously unknown myelomas that are detected by increased globulins by inclusion in a very widely requested panel justifies its inclusion.
Gareth Davies
Wrexham Maelor Hospital
> -----Original Message-----
> From: Ian Barlow [SMTP:[log in to unmask]]
> Sent: 21 January 2004 08:54
> To: [log in to unmask]
> Subject: Re: Should AST be measured?
>
> Not sure about sodium or Hb. However, my local experience with regard to effects of hyperproteinaemia on sodium suggest that unless the protein is monoclonal IgM and the concentration is extremely high, the differences between direct and non-direct reading ISEs are small.
>
> Regarding the clinical value of detecting unsuspected paraproteins I think the answer is an unequivocal yes because frequently we detect unsuspected myeloma patients in this way. Remember, not all patients present with classical symptoms of bone destruction, hypercalcaemia, renal failure etc. Regarding detection of MGUS cases - again I believe the answer is yes since approx 30% of such cases will go on to develop full blown myeloma and surely on this basis regular monitoring is likely to be effective.
> Ian
>
> -----Original Message-----
> From: Jonathan Kay [mailto:[log in to unmask]]
> Sent: Wednesday, January 21, 2004 8:43 AM
> To: Ian Barlow; [log in to unmask]
> Cc: Jonathan Kay
> Subject: Re: Should AST be measured?
>
>
>
> But is there any clinical value in detecting them?
>
>
> Is the extra expenditure worth it to detect them if there is any clinical value?
>
>
> Wouldn't it be sensible to add the assay of total protein to requests for plasma sodium or blood haemoglobin (perhaps with an age cut-off) as well as "LFT" if the answer to the first two questions is positive?
>
>
> Jonathan
>
>
>
> On 21 Jan 2004, at 8:23, Ian Barlow wrote:
>
>
> I could't agree more with Richard Mainwaring-Burton.
>
> I conducted a local survey a few years ago and established that 74% of all new paraprotein bands were detected on the basis of laboratory, and not clinically, initiated testing.
>
> Best wishes.
>
> Ian Barlow
>
> Scunthorpe
>
> UK
>
> -----Original Message-----
>
> From:Mainwaring-Burton Richard (RGZ) [mailto:[log in to unmask]]
>
> Sent:Tuesday, January 20, 2004 6:01 PM
>
> To:[log in to unmask]
>
> Subject:Re: Should AST be measured?
>
>
> Had I removed TP from my LFT, I would have now just completely missed a 31 g/L paraprotein in a 60 yr old which was spotted by the computer with globulins of 52 g/L and TP of 94 g/L. Everything else normal
>
> with best wishes
>
>
> Richard
>
>
>
>
> Richard Mainwaring-Burton
>
> Consultant Biochemist
>
> Queen Mary's Hospital
>
> Sidcup, Kent
>
> DA14 6LT
>
> 020-8308-3084
>
> -----Original Message-----
>
> From:Corns, Cathryn [mailto:[log in to unmask]]
>
> Sent:20 January 2004 12:11
>
> To:[log in to unmask]
>
> Subject:Re: Should AST be measured?
>
>
> In a past life in Romford, I removed TP from LFTs, with barely a squeak from anyone; we also removed phosphate from the bone profile, but kept it freely available as a separate test. Don't know whether this continued after I left though.
>
>
>
> Cathryn Corns
>
> Head of Biochemistry
>
> Southend Hospital
>
> 01702 435555 ext 4058
>
> -----Original Message-----
>
> From:Graham Jones [mailto:[log in to unmask]]
>
> Sent:19 January 2004 23:38
>
> To:[log in to unmask]
>
> Subject:Re: Should AST be measured?
>
>
> Dear Colleagues,
>
>
> > AST was removed from (nearly all) our routine LFT pr> ofiles for over 6 years ago. It is available as an individual request without limitation. We do slightly under 10% as many AST's as LFTs. We do it for any clinical trial where they request it and pay for it (although the costs of the AST reagent are minimal compared to keeping the clients happy). We do it for several clinical requesters who have demanded it (including several where the reason is that they may take their business elsewhere).
>
>
> From the pathology point of view it is my understanding that AST is a better marker of chronic hepatitis (eg monitoring for recurrence of liver damage in chronic Hep B or Hep C infection or alcohol abuse) and as an occasional assistance in interpretation of an ALT (Deritus ratio).
>
>
> Labs which report ASTs routinely as part of LFTs not uncommonly find isolated elevations which turn out to be skeletal or cardiac muscle damage. While this may be useful in these few cases I personally do not support this argument for inclusion of AST as this is turning the "LFT" request into "Liver and a few other organs Function Test". Of course if we want to do that let's throw in a CRP (made in the liver) and include LD as well. Chasing the unexpected positives should keep us all busy.
>
>
> Anyone had luck removing total protein from LFT's? (Watts, Burnett and Cheshire.Clin. Chem., 2000; 46: 1022-1023)
>
>
> Regards,
>
>
> Graham
>
>
> Dr Graham Jones
>
> Staff Specialist in Chemical Pathology
>
> St Vincent's Hospital, Sydney
>
> Ph: (02) 8382-9160
>
> Fax: (02) 8382-2489
>
>
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