-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]]On Behalf Of Jonathan Kay
Sent: 01 September 2006 12:36
To: [log in to unmask]
Subject: Clinical transferability of reports

I was about to reply along exactly the same lines as James. (But I would describe what we need as "clinical transferability" rather than "common reference intervals".)

This lack of transferability impedes attempts at knowledge management for laboratory medicine, as well as the development of computerised patient records. It's probably also clinically dangerous.

See also the previous debate about glycated haemoglobin.

The irony of course is that for domains where text is the output (eg radiology reports) the problem is less acute, as clinicians always have to try to understand what is in the report, and know that eg different radiologists report differently. (And that intentionally says "acute" and not "serious".)

Jonathan

On 1 Sep 2006, at 12:25, Hooper James wrote:

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From: Hooper James
Sent: 01 September 2006 12:24
To: 'Hullin Dave'
Subject: RE: LDH

Yet another reason for having national reference intervals! We shoot ourselves in the foot as far as governmental agencies are concerned. Here we are, probably the most computer-conscious discipline within medicine, supporting the electronic health record (available anywhere nationally) and we can’t even agree common reference intervals! We don’t need endless debates about minor method differences – it’s the outcome that matters. We need to move quickly for credibility’s sake.

James Hooper

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From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Hullin Dave
Sent: 31 August 2006 17:14
To: [log in to unmask]
Subject: LDH

There seems to me a fundamental problem with the Imrie classification of pancreatitis (which incidentally has been enshrined in UK guidelines (Gut 1998 42 (suppl 2 : S! –S13)) in that the LDH criteria are given as an absolute level.  Thus, they define one marker of severity as LDH > 600 U/L.  A quick glance at any EQA scheme demonstrates that laboratories report this as anything between 300 and 1000 U/L depending, amongst other things, on whether they measure lactate to pyruvate or vice versa.  Clearly, until we as a profession rectify this situation (if we ever do) the guidelines should be phrased in multiples of the local upper limit of normal not absolute levels.

Another example of the dangers of other professional groups thinking they can issue guidelines without consulting the relevant people.  As these are UKguidelines should the ACB Scientific Committee be looking out for and responding to this and similar exercises?

Dave Hullin

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