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Thanks I'm not suggesting anything (yet). I'm trying to understand the source of the problem. Jonathan PS: Clinical Biochemistry doesn't do protein electrophoresis In Oxford. Sent from my iPhone On 9 Jun 2011, at 10:52, "Colley, Michael" <[log in to unmask]> wrote: > Jonathan > > Are you suggesting we should vet Electrophoresis requests? How do we decide what is appropriate? > > Michael > > -----Original Message----- > From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Kay > Sent: 08 June 2011 11:55 > To: [log in to unmask] > Subject: Managing demand for serum protein electrophoresis > > I don't understand why these bands are being spotted in asymptomatic patients > > How much of this problem occurs because of inappropriate requests for protein electrophoresis? > > How much of it occurs because clinical biochemistry laboratories assay plasma total protein when it isn't needed? > > Jonathan > > > On 8 Jun 2011, at 11:37, Gethin Roberts (Hywel Dda Health Board - Biochemistry) wrote: > >> Dear Michael >> >> Thanks for raising this issue which we are trying to standardize in Wales at the moment. >> >> As far as I can see the most relevant guidelines are: >> >> UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): Guidelines for the investigation of newly detected M-proteins and the management of Monoclonal Gammopathy of Undetermined Significance (MGUS). 2009. >> >> These are available on the BCSH website: >> >> http://www.bcshguidelines.com/4_HAEMATOLOGY_GUIDELINES.html >> >> Although these give comprehensive information they don't address the issue of a realistic lower end cutoff for NOT performing immunofixation BUT reporting the finding of an abnormal band with a comment such as: >> >> "Faint paraprotein bands, such as this, are not uncommon in the elderly and may not be clinically significant." With a possible suggestion to repeat in 6-12 months >> >> Haematologists in Wales seem to be comfortable with this for the faintest bands (in my personal experience we are looking at bands found in the elderly >70y. which are difficult to distinguish from the background other than in good light and which, when quantitated give a level of 1g/L or less). >> >> I would be interested to know whether other colleagues have a realistic pragmatic policy on this. >> >> Gethin Roberts >> Cons Clinical Biochemist >> 01970 63(5784) WHTN 0-1822 5784 >> >> -----Original Message----- >> From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Ryan, Michael >> Sent: 08 June 2011 09:16 >> To: [log in to unmask] >> Subject: managing demand for serum protein electrophoresis >> >> Dear Colleagues, >> >> We have been trying to reach agreement with our haematological colleagues on a concensus threshold for quantifying and fixing small bands in asymptomatic patients. Does anyone have a protocol for this they would be willing to share or point me to a reputable guideline ? The issue of new bands and follow up bands is also contentious. >> >> Thanks in advance, >> >> Michael Ryan >> > > ------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. 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