Dear Ali,

 

Back before I retired I thought a great deal about your question. My approach was the reverse of yours or maybe of what is now current, perhaps partly because of the cost at that time of quantitating immunoglobulins. Although it is necessary to curb the unnecessary repetition of protein electrophoresis I think an initial test can yield invaluable information. Suppressed or elevated immunoglobulins are important evidence of active disease, but isn’t it also important to document when a gammopathy is first detected; also IgD and the rare IgE gammopathies would be missed if you wait for immunoglobulin suppression.

 

Mark

 

Dear Colleagues

One of the areas in which we have been trying to address and rationalize is serum protein electrophoresis.

Over the last few months we have been able to cut the number of the request for [log in to unmask] by almost 50% by scrutinizing every request for protein electrophoresis with reflex immunolgobulins measurement, those requests with normal immunolgobulins ( i.e. no biochemical evidence of protein electrophoresis or even single raised or suppressed immunoglobulin) were declined for protein electrophoresis, our consultant haematologists (based on their local guidelines) are happy with this policy, as they are not interested in patients with normal immunoglobulin because they are not going to intervene.

I wound be most obliged if you could share with us your experience or  local guidelines or criteria for selection for serum protein electrophoresis other than immunoglobulins at your local departments or trust.

 

Kind Regards

Ali

 

Dr Ali Al-bahrani MBCh.B MSc. CSci. FRCPath.
Consultant Chemical Pathologist and HOD of Chemical Pathology
St Mary's Hospital
Newport
Isle of Wight
PO30 5TG
United Kingdom
Te: 01983 534859/534917 Fax. 01983 825437