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I could't agree more with Richard Mainwaring-Burton.
I conducted a local survey a few years ago and established that 74% of all new paraprotein bands were detected on the basis of laboratory, and not clinically, initiated testing.
Best wishes.
Ian Barlow
Scunthorpe
UK
-----Original Message-----
From: Mainwaring-Burton Richard (RGZ) [mailto:[log in to unmask]]
Sent: Tuesday, January 20, 2004 6:01 PM
To: [log in to unmask]
Subject: Re: Should AST be measured?

Had I removed TP from my LFT, I would have now just completely missed a 31 g/L paraprotein in a 60 yr old which was spotted by the computer with globulins of 52 g/L and TP of 94 g/L. Everything else normal
with best wishes

Richard

Richard Mainwaring-Burton
Consultant Biochemist
Queen Mary's Hospital
Sidcup, Kent
DA14 6LT
020-8308-3084

-----Original Message-----
From: Corns, Cathryn [mailto:[log in to unmask]]
Sent: 20 January 2004 12:11
To: [log in to unmask]
Subject: Re: Should AST be measured?

In a past life in Romford, I removed TP from LFTs, with barely a squeak from anyone; we also removed phosphate from the bone profile, but kept it freely available as a separate test.  Don't know whether this continued after I left though.
 
Cathryn Corns
Head of Biochemistry
Southend Hospital
01702 435555 ext 4058
-----Original Message-----
From: Graham Jones [mailto:[log in to unmask]]
Sent: 19 January 2004 23:38
To: [log in to unmask]
Subject: Re: Should AST be measured?

Dear Colleagues,

AST was removed from (nearly all) our routine LFT profiles for over 6 years ago. It is available as an individual request without limitation. We do slightly under 10% as many AST's as LFTs. We do it for any clinical trial where they request it and pay for it (although the costs of the AST reagent are minimal compared to keeping the clients happy). We do it for several clinical requesters who have demanded it (including several where the reason is that they may take their business elsewhere).

From the pathology point of view it is my understanding that AST is a better marker of chronic hepatitis (eg monitoring for recurrence of liver damage in chronic Hep B or Hep C infection or alcohol abuse) and as an occasional assistance in interpretation of an ALT (Deritus ratio).

Labs which report ASTs routinely as part of LFTs not uncommonly find isolated elevations which turn out to be skeletal or cardiac muscle damage. While this may be useful in these few cases I personally do not support this argument for inclusion of AST as this is turning the "LFT" request into "Liver and a few other organs Function Test". Of course if we want to do that let's throw in a CRP (made in the liver) and include LD as well. Chasing the unexpected positives should keep us all busy.

Anyone had luck removing total protein from LFT's? (Watts, Burnett and Cheshire. Clin. Chem., 2000; 46: 1022-1023)

Regards,

Graham

Dr Graham Jones
Staff Specialist in Chemical Pathology
St Vincent's Hospital, Sydney
Ph: (02) 8382-9160
Fax: (02) 8382-2489

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------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.

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------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.

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