In this case,you should kick the ball to the physicians. Whenever they
request the test, there should be an indication leading to the diagnosis. I
have several cases of elevated CK and CK-MB due to muscular disease
(dystrophy), e.g., you would't make a MI diagnosis with a highly elevated CK
and CK-MB in a 3-year old babys even though cTnT is positive. In this case,
the first comes acroos the mind is the muscular disorder. Actually, this is
also the weakness for cTnT although it is assumed to be more specific in the
third generation assay but still has higher percentage of false positive in
ESRD and Muscular disease compared with cTnI (we have less problem with
cTnI). SO back to "Should we reflexly measure Troponin T in these cases"? I
think it's up to the physician's judge when or whether to order as the
clinical indication is also relevant (or we can give advice in combination
of clinical findings). Patient's history and clinical findings are always
relevant!
Qing Meng MD, PhD, FCACB, DABCC
>From: "Mainwaring-Burton Richard (RGZ)"
><[log in to unmask]>
>Reply-To: "Mainwaring-Burton Richard (RGZ)"
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: REFLEX TEST FOR TROPONIN T
>Date: Tue, 4 Jan 2005 12:02:38 -0000
>
>Why not drop the CK-MB and save some money for the new Year and use
>troponin
>as your front line marker. The only drawback is the time window of 12 hours
>for troponin.
>
>with best wishes for a HNY
>
>Richard
>
>Richard Mainwaring-Burton
>Consultant Biochemist
>Queen Mary's Hospital
>Sidcup, Kent
>DA14 6LT
>020-8308-3084
>
>-----Original Message-----
>From: Sharpe, Peter Dr [mailto:[log in to unmask]]
>Sent: 04 January 2005 11:53
>To: [log in to unmask]
>Subject: REFLEX TEST FOR TROPONIN T
>
>
>Dear All,
>
>I'm just wondering what other labs do in the case of raised CK-MB levels in
>patients where there are no clinical details or obvious history of
>myocardial ischaemia. We automatically measure Troponin T, and in the
>majority of cases find it to be < 0.01 ug/l. However, we have had 2 recent
>raised Troponin T levels which have initiated further investigations
>including admission to hospital. Both patients had inflammatory muscle
>disorders which can lead to raised Troponin T concentrations. None of the
>patients had evidence of ischaemic heart disease and both had normal Echos.
>
>My question is "Should we reflexly measure Troponin T in these cases"? What
>do other labs do?
>
>Happy New Year
>
>Peter
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