In message <[log in to unmask]>, Mike Addison
<[log in to unmask]> writes
>I have just come off the phone after a rather acrimonious
>discussion with one of our paediatric intensivists. He had been
>upset at the laboratories unwillingness to sanction a repeat gamma
>GT on one of his patients. After the discussion I agreed to do the
>test under protest but was I right to question the request? As we
>get few requests for this test they are sent to our neighbouring
>adult hospital and take 24 hours.
>
>The patient is a 7 month male infant admitted with meningococcal
>sepsis. He was severely ill with multiple organ failure. His ALT
>rose from 16iu/L to 820 at 24 hours and 2200 at 72 hours. It fell
>rapidly at first and then more slowly over the next 6 days to
>167iu/l.and then rose slightly to 215 over the next three days. At
>the same time bilirubin rose from 5 micromol/l to 250(60%
>conjugated) but the alkaline phosphatase remained essentially the
>same with minor fluctuation about the middle of our normal range
>for his age. Albumin was also normal but the child has been
>receiving 100ml packed RBCs per day and is on TPN.
>
>The first gamma GT was asked for when the ALT was 175 (day 11
>0f his admission) The result was 77iu/l (upper adult limit 70). A
>repeat was requested the next day which the lab queried on the
>ground of the previous result.
>
>The refusal was not noticed for nearly 24 hours when I was
>telephoned. The intensivist stated that repeat gamma GT was
>required to establish a differential diagnosis of the continuing liver
>disorder and that they would need to monitor it on a daily basis.
>
>The value of gamma GT in children is fairly limited despite the
>problems with alkaline phosphatase and age related reference
>ranges. I know of only one indication for daily gamma GT, in liver
>transplants. So what are the others either in children or adults?
>How can a marginally raised gamma GT be interpreted in a child
>with multi-organ disease on many drugs including antibiotics?
>I asked my 'colleague' for his evidence but he said it was up to me
>to show that gamma GT would not help him. He could not give me
>a differential diagnosis over the phone which made much clinical
>sense in a child with a known disorder.
>
>All advice gratefully received even if it proves me wrong. Other
>information can be provided if necessary but I am too frightened to
>go onto PICU to get his notes at the moment!!
>
>Mike Addison
>Dr G.Michael Addison
>Royal Manchester Children's Hospital
>Pendlebury
>Manchester M27 4HA
>United Kingdom
>
>Tel 0161-727-2250(AM)or 0161-220-5342(PM)
>FAX 0161-727-2249
>Email [log in to unmask]
There is no need to repeat LFT's of any sort more than 2 per week - they are not
used to select for liver transplants (go on Wiliam - prove me wrong)
BUT - why don't you do them - a lab without GGT is not a proper lab -I use GGT
all the time in cardiac disease Rx for monitoring
paul collinson
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