The problem with trying to establish some kind of cut off is the variability
in the urine protein methodologies. Few are optimised for globulins let
alone BJP. Some methods underestimate light chain concentrations by upto
70%. So variability in methods across labs plus variability in urine
protein composition make this elusive.
> ----------
> From: Elizabeth Mac Namara[SMTP:[log in to unmask]]
> Reply To: Elizabeth Mac Namara
> Sent: 12 November 2002 16:14
> To: [log in to unmask]
> Subject: Re: BJPs
>
> 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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