David,
If you have unlimited amounts of analyte-free diluent matching the matrix of the clinical sample at hand, things are easy and you could go ahead with manual dilutions. This is however not always the case and/or prohibitively expensive. In individual cases (I remember a homocystein exceeding 150 µmol/L) we have selected other clinical samples with very low/near zero concentrations of the analyte under consideration and used these for dilutions and with a little mathematics you can establish a final result. A specific comment on this procedure in provided with the report.
With regard to clinical needs, extremely elevated CK may be needed in numbers for monitoring rhabdomyolysis. I personally would not dilute out RF > 3,500 which for my understanding is a very unusual finding. Some tumor markers (for example HCC with AFP > 1,000,000) require a lot of dilutional work but our medical oncologists insist on these numbers.
Best regards,
Mike
PD Dr. med. Michael Steiner
D-18059 Rostock
Germany
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