Sorry folks, am I missing something? Why are so many debating the inclusion of TP in the liver profile, apparently in an attempt to pick up unsuspected paraproteins? Seems to me we might just as well put it in the U&E if that's the aim.
Personally, I would agree with Bharat and put it in the bone profile on the rationale that patients with undiagnosed myeloma are likely to go to their GP with bone pain, and hence a bone profile is likely to be requested. We do masses of LFTs simply for monitoring drug therapy, and I can't see the value of looking for unsuspected myeloma in repeated samples for patients with absolutely no indication.
Best wishes
Mrs Angela Woods
Consultant Biochemist
East & North Herts NHS Trust
---- Original message ----
>Date: Fri, 11 May 2007 14:40:11 +0100
>From: IAN WATSON <[log in to unmask]>
>Subject: Re: Standardised Test Profiles
>To: [log in to unmask]
>
>As has been pointed out by Martin Myers this is an important debate that
>we need to have explored thoroughly so that when Commissioners are using
>PbR we can give a coherent consensus rationale for what we are doing. I
>would suggest that we should be looking to determine the minimum order
>set compatible with meaningful interpretation in the majority (?>90%) of
>patients and we should consider context i.e. hospital v GP.
> it may be that we can save a lot of money by not doing GP ureas, but
>that should be reinvested in adding T4 to TSH if not already done.
>If we don't determine our own minimum quality standards, someone else
>will.
>So is it?:
>renal: Na K creat urea [hospital] Na K creat (+ eGFR)[GP]
>liver: Bili ALT or AST ALP ?+tot prot alb
>bone Ca Alb PO4 ALP
>Thyroid TSH (f)T4
>
>The % of reflex tests added to each profile might become relevant if
>high numbers, so some consideration of that too is needed.
>
>
>
>
>
>
>
>Dr Ian D Watson
>Consultant Biochemist & Toxicologist
>Dept Clinical Biochemistry
>University Hospital Aintree
>Liverpool
>L9 7AL
>tel 01515293575
>
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