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)."
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.
Dr Tanya Hart
Department of Clinical Biochemistry
Poole and Royal Bournemouth Hospitals
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Subject: NICE guideline NG35
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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?
Senior Clinical Scientist
Shrewsbury and Telford Hospital NHS Trust
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