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ACB-CLIN-CHEM-GEN  March 2016

ACB-CLIN-CHEM-GEN March 2016

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Subject:

Re: NICE guideline NG35

From:

"Salter Simon (ROYAL FREE LONDON NHS FOUNDATION TRUST)" <[log in to unmask]>

Reply-To:

Salter Simon (ROYAL FREE LONDON NHS FOUNDATION TRUST)

Date:

Thu, 3 Mar 2016 10:09:37 +0000

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I think it is a poorly worded way of recommending that SLCH should be used first line. We are planning on going down that route at the Royal Free with SLCH for GPs rather than urine  immunofixation/electrophoresis. 
 
The full guideline has the evidence on which it was based: http://www.nice.org.uk/guidance/ng35/evidence/full-guideline-2306487277 
 
Diagnostic accuracy of laboratory tests for suspected plasma cell disorders 
 
Serum protein electrophoresis (SPE) 
 
Evidence from 4 studies including 4888 patients (McTaggart et al 2013, Hill et al 2006, 
Piehler et al 2008 and Vermeersch et al 2008) suggests serum protein electrophoresis has 
sensitivity 85% [95%C.I. 75% – 92%] and specificity of 95% [95%C.I. 85% – 98%] for the 
diagnosis of plasma cell disorders. 
 
Serum free light chain (sFLC) analysis 
 
Evidence from of 4 studies including 4888 patients (McTaggart et al 2013, Hill et al 2006, 
Piehler et al 2008 and Vermeersch et al 2008) suggests serum free light chain ratio outside 
the normal range has sensitivity of 47% [33% – 60%] and specificity of 95% [85% – 99%] for 
the diagnosis of plasma cell disorders. 
 
Combined SPE and sFLC 
 
Evidence from 3 studies including 4054 patients (McTaggart et al 2013, Hill et al 2006, 
Piehler et al 2008) suggests that combining serum free light chain analysis with serum 
protein electrophoresis, improves sensitivity for the diagnosis of plasma cell disorders with a 
pooled estimate of 94% [72% – 99%]. In this strategy patients with a negative serum protein 
electrophoresis test would go on to have a serum free light chain test. 
 
-----Original Message----- 
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Hart, Tanya 
Sent: 02 March 2016 15:02 
To: [log in to unmask] 
Subject: Re: NICE guideline NG35 
 
Our FLC reagent suppliers are not interpreting it as advice to use FLCs as a first line screen for everyone. I think the guideline is unclear on this. However I've just noticed that the NICE website itself says: 
 
"This guideline covers adults (aged 16 years and over): 
- who are referred to secondary care with suspected myeloma 
- with newly diagnosed or relapsed myeloma (including high‑risk myeloma and primary plasma cell leukaemia)." 
http://www.nice.org.uk/guidance/ng35/chapter/Context 
 
I'm not really sure what is meant by using FLCs to 'confirm the presence of a paraprotein'. I'm also surprised that the guideline claims that an abnormal FLC ratio has 95% specificity for diagnosis of plasma cell disorders. 
 
Tanya 
 
Dr Tanya Hart 
Clinical Scientist 
Department of Clinical Biochemistry 
Poole and Royal Bournemouth Hospitals 
 
 
 
-----Original Message----- 
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of McTaggart Malcolm (SHREWSBURY AND TELFORD HOSPITAL NHS TRUST) 
Sent: 02 March 2016 14:19 
To: [log in to unmask] 
Subject: NICE guideline NG35 
 
--- 
This message was sent from an email address external to NHSmail but gives the appearance of being from an NHSmail (@[log in to unmask]) address. The recipient should verify the sender and content before acting upon information contained within. 
 
The identified sender is [log in to unmask] 
--- 
Dear All 
 
Section 1.2 of this new guideline on 'myeloma: diagnosis and management' states 'use serum protein electrophoresis and serum-free light chain assay to confirm the presence of a paraprotein'. Should this be interpreted as: all myeloma screens should have serum electrophoresis and sFLC analysis? Or since most myeloma screens are negative is it not going that far given the use of the word 'confirm'. Perhaps it means sFLC should be done at least if an abnormality is detected in one of the other tests? 
 
Best wishes, 
Malcolm 
 
Malcolm McTaggart 
Senior Clinical Scientist 
Biochemistry, Pathology 
Shrewsbury and Telford Hospital NHS Trust 
 
 
DISCLAIMER: This email and any files transmitted with it are confidential and intended solely for the use of the individual, individuals or entity to whom they are addressed.  Any views or opinions expressed are those of the author and do not necessarily represent the views of Poole Hospital NHS Foundation Trust unless otherwise explicitly stated.  This email may contain confidential and/or privileged materials. In the case of confidential and/or privileged materials, any review, retransmission, dissemination or other use of these materials by individuals or entities other than the intended recipient may be the subject of legal action. If you receive an email in error from Poole Hospital NHS Foundation Trust, please contact the sender and delete the material from your computer. 
 
 
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