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We would consider adding an electrophoresis to a specimen from a GP if
 

1. the albumin/globulin ratio is less than one.

2. there is a high total protein concentration.

3. the history on the request form indicates weight loss.

4. the history on the request form indicates bone or back pain.

5. the history on the request form indicates there is a high ESR.

6. the history on the request form indicates there is macrocytosis.

Unless/

- an electrophoresis has already been performed.

- the specimen is haemolysed.

- the patient is a hospital patient

- the patient is under 40 years

- there is evidence of liver disease.

- the history on the request form suggests evidence of a protein-losing disease, e.g. nephrotic syndrome or coeliac disease.

 

I think if you don't want to know what is wrong with you, you should not go near the doctor in the first place.

Elliott

-----Original Message-----
From: Jonathan Kay [mailto:[log in to unmask]]
Sent: 21 January 2004 10:04
To: [log in to unmask]
Subject: Re: Detection of asymptomatic paraproteinaemia, was Re: Should AST be measured?

Wouldn't it be equally sensible to look for paraproteins in specimens sent with requests for eg plasma creatinine* as in specimens sent with requests for "LFT"?


Jonathan


* The previous example of plasma sodium was just an example of a common assay, nothing to do with analytical artefacts between the sodium and protein assays!



On 21 Jan 2004, at 9:11, Reynolds Tim wrote:


I have to agree - we frequently find significant paraproteinaemias because we measure total protein and follow up high values with electrophoresis. Whether it makes the patient live longer is another question but it prevents a significant number of delayed diagnoses.

TIM


On 21 Jan 2004, at 9:16, GARETH DAVIES wrote:


I've just solicited the opinion of a consultant Haematologist who holds the views that, with her laboratory-based practitioner hat on, total protein probably has no relevance in an LFT panel, but with a clinical practitioner hat on, the number of previously unknown myelomas that are detected by increased globulins by inclusion in a very widely requested panel justifies its inclusion.


Gareth Davies

Wrexham Maelor Hospital


On 21 Jan 2004, at 9:48, David Brown wrote:


Due to the current (in other circles)debate on "expert

opinion" is it wise to "defer" a treatment if it is

available? Does "insignificant" become "significant"

when it is a person and not a statistic?



David Brown




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