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
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