I have never used a cut off and will always do a urine electrophoresis if
asked. There is no good data to the contrary, that I know of, in the recent
literature. If anything the suggestion is to do immunofixation on any urine
electrophoresis which has any band other than an albumin. If the physician
has a suspicion of a patient having myeloma even if the serum is negative it
would be indefensible not to do one with both the recommendations of the
Kyle and the publication from the UK. Remembering that 15 to 20% of myelomas
are secretors of light chain only makes a refusal to do an asked for test
difficult if one does not discuss it with the physician.
On the other hand it would be good to look at a really large study across
many laboratories to see exactly what is being missed by not doing urine
protein electrophoresis and using cutoffs. I do not believe there have been
any good cost benefit analysis done in the past few years and I would be
very happy to work with some people to try and set it up and pool our data.
It would make a very useful publication. I am already trying to get
information, from my own laboratory, to disregard the publication which
states immunofixation should be done on urines which have essentially normal
patterns.
I hope to hear from a few interested people.
Elizabeth Mac Namara
Jewish General Hospital
Montreal
-----Original Message-----
From: clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of PETER HOWELL
Sent: November 12, 2002 5:54 AM
To: [log in to unmask]
Subject: BJPs
Dear MailBase
Does anyone use a cut-off for Urine Protein when being asked to look for
Bence Jones protein by electrophoresis ?
For example, is it worth performing electrophoresis on a measured total
urine protein of < 0.06 g/l ?
Are we at 'risk' of missing a Bence-Jones protein ??
Peter
Peter Howell
Head Biomedical Scientist
Medical Biochemistry Department
Wrexham Maelor Hospital
Wrexham
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