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If CPA object to any attempt to introduce such limits they will have lost the plot. Action limits are clearly what we are really here for but they are very situation specific. The action limit for exclusion prior to 'safe' discharge can be very different from that one might use when considering admission. The difficulty for us all will be knowing just what the actual situation is when appending our limits. Trevor Tickner, Norwich > -----Original Message----- > From: Eric Kilpatrick [SMTP:[log in to unmask]] > Sent: 02 May 2002 09:11 > To: [log in to unmask] > Subject: Re: ALT reference ranges > > Brian > > I posted a similar question a few months ago because we had traditionally > stated 36U/L as the upper limit for ALT, but when an academic colleague > gave > us 'normal' data from patients randomly selected from GP lists the 97.5th > centile was 53 (Beckman LX20). Because of the skewed (long tail) data it > meant that the 95th centile was considerably lower at 43. > > So where to set it? Our gastroenterologists were divided, but all agreed > 36 > was too low. However some felt 53 would miss many patients with pathology, > especially NASH. We therefore settled on 45, not as the upper limit of the > reference range, but as an 'action limit' for clinicians. > > Which raises the point of whether we should quote reference ranges or > action > limits. It seems obvious that some of the rise in ALT is due to the fact > that we are heavier and drink more than our ancestors. But we still define > obesity as >30kg/m2 even though the 'reference interval' continues to rise > in the population. So, when pathology and normality can overlap > significantly, is it appropriate to quote the reference interval? > > I guess I'll have a good time justifying our decision when CPA next come > round! > > Eric > Dr. Eric S. Kilpatrick > Consultant in Chemical Pathology > Hull Royal Infirmary > Anlaby Rd > Hull HU3 2JZ > Tel: 01482-607708 > Fax: 01482-607725 > > > --------------------------------------------------------------------------- The information contained in this e-mail is confidential and is intended only for the named recipient(s). If you are not the intended recipient you must not copy, distribute, or take any action or reliance on it. If you have received this e-mail in error, please notify the sender. Any unauthorised disclosure of the information contained in this e-mail is strictly prohibited. ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/