I was trained / educated in an era when all labs. established their own reference ranges with their own methods, population etc - well that was the theory and probably in many ways is best practice. However, we live in a digital age where a variety of health professionals who are far more mobile than they used to be, access and interpret the results and where patients too are doing exactly the same. Patients' care is being shared between regional specialist centres and their local centre. Laboratories are in networks, but not necessarily with the same kit.
A common thread in all of this is that users / patients assume that results from one laboratory are the same as those from another. Surely as responsible professionals we have a duty of care to ensure that so far as possible that is the case. In my view that does mean that there should be strong guidance / directive as to which assay principle should be used, at least for common analytes in the first instance.
I have seen patient notes where drug dosage has been changed on the strength of a result from a different laboratory where the change in the substance measured was as a result of a different analytical method used not as a result of any real change in the level of that substance.
Of course I accept that even with the same methodology results may still differ between analytical platforms. However, I suggest that by continuing to have absolute local autonomy to choose our methods and by not accepting the requirement to standardise methods that in today's environment we run the very real risk of causing patient harm. Patient's bloods etc no longer just go to their local laboratory.
Best wishes
Mike
Dr Mike Bosomworth
Clinical Service Lead for Blood Sciences and Specialist Laboratory Medicine
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-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of David James
Sent: 15 October 2015 11:06
To: [log in to unmask]
Subject: Re: ALT reference intervals
Derrr....................they assume that is the case already! Comes as a shock when they find outotherwise
-----Original Message-----
From: Jonathan Kay [mailto:[log in to unmask]]
Sent: 15 October 2015 11:01
To: David James; [log in to unmask]
Cc: Jonathan Kay
Subject: Re: ALT reference intervals
It's an excellent question.
As would be asking clinicians and patients if they'd like results to be much more transferable. It might be worth establishing that one before asking the laboratories...
Jonathan
On 15 Oct 2015, at 10:50, David James <[log in to unmask]> wrote:
> "..........................but what else can be done when laboratories don't use standardised methods?"
>
> So, a question -
>
> If someone (and let's not get hung up on who) pronounced for example -
>
> "In the UK all ALT measurements must be done by IFCC method with PP"
> (assuming that all manufacturers had that method available for their
> analysers)
>
> How many labs would decide they knew better? It's a serious question
>
> DJ
>
> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of Jonathan Kay
> Sent: 15 October 2015 10:27
> To: [log in to unmask]
> Subject: Re: ALT reference intervals
>
> IMHO it's generally better not to bring "healthy" or "normal" into this. The question is whether you can distinguish the two populations of interest. The unaffected population may not be healthy.
>
> Recommended reading, as ever: Galen and Gambino, and the NORDKEM reports from the mid 80s.
>
> And "Yes", those mentions of twice the upper limit are an attempt to get round inter-laboratory variation. A third-rate attempt, but what else can be done when laboratories don't use standardised methods?
>
> Jonathan
>
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