Stephen du Toit, Chemical Pathologist

Transcription

1 Stephen du Toit, Chemical Pathologist

2 LabPLUS MMH NSH LTA Pathlab Elysia- who suffers me gracefully year round

3

4 baptism onomasiology designation title naming orismology name heading nuncupation onomatopoeia appellation nomination antonomasia appellative denomination Source: onomasiology : the branch of semantics concerned with the meanings of and meaning relations between individual words

5 Serum Paraprotein or Monoclonal immunoglobulin Monoclonal free light chains Urine Paraprotein, BJP or monoclonal free light chains Intact = Monoclonal immunoglobulin

6 TP and albumin available for assessment of SPE Albumin BCP preferred Report globulins Lowest limit for paraprotein quantification = 1 g/l Delineation of paraprotein reported Determine upper limit of agreement between paraprotein and immunoglobulin measurement Paraprotein in beta region reported as Beta+ paraprotein

7 TP reported Measured (BCP) albumin and globulins reported with SPE - LTA Immunoglobulins only reported when requested Reports are cumulative within a laboratory Fractions are only reported by interpretive commenting In reports A small monoclonal band was detected A faint discrete band The previously detected monoclonal protein

8 Referral to haematologist Response criteria Special authority for Bortezomib includes stipulation that 2 nd half of 8 cycles can only be given if partial response (50%) at completion of cycle 4

9 LabPLUS < 2.0 g/l MMH < 1.0 g/l North shore < 1.0 g/l LTA < 1.0 g/l 1 Decimal place up to 10 g/l, then whole numbers Pathlab Band quantification < 1 g/l 7 of 10 labs Waikato QC quantify paraprotein

10 Upper limit of agreement between immunoglobulins and paraprotein quantification: 2 laboratories have investigated, 1 limited study and 1 study from Laboratory reports how paraprotein is delineated

11 Bands in beta region reported as Beta + paraprotein LTA currently subtract beta but will/have change to beta + Pathlab can separate band in beta region with CZE NSH subtract beta but usually separated by CZE Lab Plus beta + paraprotein MMH beta +paraprotein

12 SERUM PROTEIN ELECTROPHORESIS: There is a small discrete band in the early gamma region. This band was previously reported as IgG with lambda light chains.

13 The electrophoretic quantification only includes the paraprotein, while an immunoglobulin measurement includes both monoclonal and polyclonal immunoglobulins. For follow-up it is important to compare results with the same method

14 Detection limit should be known, ideally < 0.01 g/l Creatinine should be reported on every sample BJP reported as creatinine ratio Intact immunoglobulin reported as creatinine ratio Do not use serum free light chain assay

15 LTA BJP monoclonal free kappa (0.01 g/l) Paraprotein/Creat Ratio LabPLUS Free kappa light chains (0.009 g/l) Paraprotein/Creat ratio Pathlab BJP monoclonal kappa (0.02 g/l) Paraprotein/Creat ratio North shore - refer MMH not quantified WDHB Bence Jones protein. (0.01 g/l) Not quantified Intact monoclonal immonoglobulin ratio variably reported

16 SPE Auckland region meets most recommendations Waikato - WDHB need to quantify paraprotein 3/10 need to quantify paraprotein BJP Auckland region most meets most recommendations Waikato - WDHB needs to quantify BJP

17 Thank You!