I don't understand why these bands are being spotted in asymptomatic patients
How much of this problem occurs because of inappropriate requests for protein electrophoresis?
How much of it occurs because clinical biochemistry laboratories assay plasma total protein when it isn't needed?
Jonathan
On 8 Jun 2011, at 11:37, Gethin Roberts (Hywel Dda Health Board - Biochemistry) wrote:
> Dear Michael
>
> Thanks for raising this issue which we are trying to standardize in Wales at the moment.
>
> As far as I can see the most relevant guidelines are:
>
> UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): Guidelines for the investigation of newly detected M-proteins and the management of Monoclonal Gammopathy of Undetermined Significance (MGUS). 2009.
>
> These are available on the BCSH website:
>
> http://www.bcshguidelines.com/4_HAEMATOLOGY_GUIDELINES.html
>
> Although these give comprehensive information they don't address the issue of a realistic lower end cutoff for NOT performing immunofixation BUT reporting the finding of an abnormal band with a comment such as:
>
> "Faint paraprotein bands, such as this, are not uncommon in the elderly and may not be clinically significant." With a possible suggestion to repeat in 6-12 months
>
> Haematologists in Wales seem to be comfortable with this for the faintest bands (in my personal experience we are looking at bands found in the elderly >70y. which are difficult to distinguish from the background other than in good light and which, when quantitated give a level of 1g/L or less).
>
> I would be interested to know whether other colleagues have a realistic pragmatic policy on this.
>
> Gethin Roberts
> Cons Clinical Biochemist
> 01970 63(5784) WHTN 0-1822 5784
>
> -----Original Message-----
> From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Ryan, Michael
> Sent: 08 June 2011 09:16
> To: [log in to unmask]
> Subject: managing demand for serum protein electrophoresis
>
> Dear Colleagues,
>
> We have been trying to reach agreement with our haematological colleagues on a concensus threshold for quantifying and fixing small bands in asymptomatic patients. Does anyone have a protocol for this they would be willing to share or point me to a reputable guideline ? The issue of new bands and follow up bands is also contentious.
>
> Thanks in advance,
>
> Michael Ryan
>
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