RESUMEN
Analysis of serum lipoprotein fractions by electrophoresis (lipoprotein electrophoresis) reveals lipid metabolism disorders, and provides various types of bio-information which lead to an accurate diagnosis and effective treatment for dyslipidemia and related diseases (e.g., coronary artery disease or chronic kidney disease). In particular, lipoprotein electrophoresis enables us to define the phenotypes of dyslipidemia, and to detect abnormal lipoproteins, which are potent biomarkers of atherosclerotic disease. In addition, lipoprotein electrophoresis is an indispensable complement to other assay methods for serum lipid component measurement that have some limitations, such as a homogeneous assay for LDL-C. However, it appears to be underestimated regarding its clinical usefulness. Indeed, the fee for lipoprotein electrophoresis tests is too low. This review specifically discusses the clinical usefulness and problems of lipoprotein electrophoresis, with a special emphasis on cost.
Asunto(s)
Electroforesis de las Proteínas Sanguíneas/economía , Electroforesis de las Proteínas Sanguíneas/métodos , Técnicas de Laboratorio Clínico , Costos y Análisis de Costo , Dislipidemias/diagnóstico , Honorarios y Precios , Lipoproteínas/sangre , Lipoproteínas/aislamiento & purificación , Aterosclerosis/sangre , Aterosclerosis/diagnóstico , Dislipidemias/sangre , Dislipidemias/tratamiento farmacológico , HumanosRESUMEN
Screening for monoclonal gammopathies is usually done by serum protein electrophoresis (SPEP) and serum free light chain tests. SPEP may be followed by immunofixation electrophoresis (IFE). IFE may be ordered by the treating physician or be at the discretion of the pathologist. We examined the appropriateness of IFE ordering by treating physicians and report on our findings, follow-up changes to the ordering process, and results of the change. We retrospectively analyzed the data from our laboratory from April 2009 through July 2012. In April 2009, 3 options for test ordering were available for the clinicians: SPEP with reflex IFE, SPEP only, and SPEP with IFE. This test ordering option was limited to SPEP with reflex IFE only in April 2010. We compared the rates of SPEP and IFE performed in the 2 periods (ie, April 2009 through April 2010 and May 2010 through July 2012). There was a substantial drop in the IFE/SPEP ratio from 0.47 to 0.21. Review of electronic medical records by the consultant pathologist was instrumental in improving the utilization and enhancing the value of pathology consultation. Possible impacts on laboratory costs, revenue, and overall health care are also presented.
Asunto(s)
Electroforesis de las Proteínas Sanguíneas/métodos , Electroforesis/estadística & datos numéricos , Paraproteinemias/diagnóstico , Electroforesis de las Proteínas Sanguíneas/economía , Electroforesis de las Proteínas Sanguíneas/estadística & datos numéricos , Cadenas Ligeras de Inmunoglobulina/sangre , Paraproteinemias/sangre , Pautas de la Práctica en Medicina , Derivación y Consulta , Estudios RetrospectivosRESUMEN
BACKGROUND: Peripheral neuropathy is a common disorder in which an extensive evaluation is often unrevealing. METHODS: We sought to define diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care. The 1996-2007 Health and Retirement Study Medicare claims-linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months. Focusing on 15 relevant tests, we examined the number and patterns of tests and specific test utilization 6 months before and after the incident neuropathy diagnosis. Medicare expenditures were assessed during the baseline, diagnostic, and follow-up periods. RESULTS: Of the 12, 673 patients, 1031 (8.1%) received a new International Classification of Diseases, Ninth Revision, diagnosis of neuropathy and met the study inclusion criteria. Of the 15 tests considered, a median of 4 (interquartile range, 2-5) tests were performed, with more than 400 patterns of testing. Magnetic resonance imaging of the brain or spine was ordered in 23.2% of patients, whereas a glucose tolerance test was rarely obtained (1.0%). Mean Medicare expenditures were significantly higher in the diagnostic period than in the baseline period ($14,362 vs $8067, P < .001). CONCLUSIONS: Patients diagnosed as having peripheral neuropathy typically undergo many tests, but testing patterns are highly variable. Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests. Expenditures increase substantially in the diagnostic period. More research is needed to define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy.
Asunto(s)
Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Gastos en Salud , Medicare/economía , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Anciano , Anticuerpos Antinucleares/sangre , Recuento de Células Sanguíneas/economía , Recuento de Células Sanguíneas/estadística & datos numéricos , Electroforesis de las Proteínas Sanguíneas/economía , Electroforesis de las Proteínas Sanguíneas/estadística & datos numéricos , Sedimentación Sanguínea , Encéfalo/patología , Electromiografía/economía , Electromiografía/estadística & datos numéricos , Femenino , Prueba de Tolerancia a la Glucosa/economía , Prueba de Tolerancia a la Glucosa/estadística & datos numéricos , Hemoglobina Glucada/análisis , Humanos , Clasificación Internacional de Enfermedades , Imagen por Resonancia Magnética/economía , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Conducción Nerviosa , Enfermedades del Sistema Nervioso Periférico/economía , Enfermedades del Sistema Nervioso Periférico/epidemiología , Garantía de la Calidad de Atención de Salud , Columna Vertebral/patología , Tirotropina/sangre , Estados Unidos/epidemiología , Vitamina B 12/sangreRESUMEN
BACKGROUND: Retrospective analyses have established the role of quantitative serum free light chains (FLCs) in the diagnosis of monoclonal light chain disorders. The aims of this study were to assess (a) whether the addition of serum FLCs to serum protein electrophoresis (SPEP) identified additional patients with monoclonal gammopathies; (b) whether serum FLC measurements could replace urinalysis for Bence Jones protein (BJP); and (c) the cost/quality implications of routinely measuring serum FLCs. METHODS: Serum FLCs were added to consecutive requests for SPEP from August to November 2004 and measured by automated immunoassay. RESULTS: Seventy-one of 923 patients had abnormal serum FLC ratios. Seven patients with monoclonal gammopathies and 1 patient with malignant lymphoma (but no monoclonal band) were detected among 43 patients with negative SPEP but positive serum FLC ratios. Thirty-five patients with negative SPEP had false-positive serum FLC ratios. The false-positive rate for a ratio >1.65 was higher than previously described and associated with polyclonal increases in immunoglobulins and renal impairment. Serum FLC ratios were normal in 2 of 13 patients with low-level persistent urine BJP. However, no significant pathology would have been missed by replacing BJP with serum FLCs. Revenue and manpower savings offset 60% of the costs of serum FLCs. CONCLUSIONS: Additional diagnostic information is gained by adding serum FLCs to SPEP as first-line tests for investigating possible B-cell disorders. The quality of the diagnostic service is enhanced by more confident exclusion of light chain disorders and improved interpretive assessment of SPEP and immunofixation electrophoresis.
Asunto(s)
Proteína de Bence Jones/orina , Cadenas kappa de Inmunoglobulina/sangre , Cadenas lambda de Inmunoglobulina/sangre , Paraproteinemias/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Electroforesis de las Proteínas Sanguíneas/economía , Reacciones Falso Positivas , Femenino , Humanos , Inmunoelectroforesis/economía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Control de Calidad , SueroRESUMEN
In setting up a diagnostic myeloma laboratory the popular, highly automated and otherwise excellent choices of equipment and laboratory practices, so exorbitantly raise costs that the sustainability, even in large government hospitals in third world countries may become difficult. Based on our experience in a regional cancer center in India, we offer here, guidelines for carrying out high resolution electrophoresis, densitometry, immunofixation and urine concentration. We show that by simply employing well established techniques and doing them properly, one can get results of excellent quality at minimum cost and minimum dependence on costly imports.
Asunto(s)
Laboratorios de Hospital/economía , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/economía , Electroforesis de las Proteínas Sanguíneas/economía , Técnicas de Laboratorio Clínico/economía , Costos y Análisis de Costo , Densitometría/economía , Humanos , Inmunoensayo/economía , India , Mieloma Múltiple/metabolismo , Proteínas de Mieloma/análisis , Urinálisis/economíaRESUMEN
The logistical details for organizing effective interpretive rounds in a laboratory medicine subspecialty must be carefully established so that expert opinions are provided in a timely fashion in a patient-specific report, rather than as a collection of fixed comments associated with a particular laboratory result generated by a computer This report describes the test batteries for interpretations, the billing for interpretations, clinical examples of interpretations, and interpretations for which billing is not typically performed in several clinical or laboratory areas in our institution. These include coagulation disorders, hemoglobin and anemia evaluations, autoimmune disorders, serum protein analysis, toxicology, molecular diagnostics, and transfusion medicine. The information in this report should provide sufficient detail to allow development of interpretive services with successful billing for the areas in laboratory medicine described.
Asunto(s)
Técnicas de Laboratorio Clínico , Anemia/diagnóstico , Enfermedades Autoinmunes/diagnóstico , Trastornos de la Coagulación Sanguínea/diagnóstico , Electroforesis de las Proteínas Sanguíneas/economía , Transfusión Sanguínea/economía , Técnicas de Laboratorio Clínico/economía , Testimonio de Experto , Humanos , Registros Médicos , Biología Molecular , Mecanismo de Reembolso , Toxicología/economíaRESUMEN
The follow-up of patients with monoclonal gammopathies at our institution includes serial serum protein electrophoresis (SPE) with densitometry and IgG, IgA, and IgM quantitative immunoglobulin (QIG) determinations by rate nephelometry. This retrospective audit compares monoclonal protein concentration as estimated by SPE versus QIG in 456 serial serum specimens from 105 patients to determine whether any of the tests provide redundant information. A comparison of the methods demonstrated good correlation between SPE (x-axis) and QIG (y-axis) quantitation for each immunoglobulin class: IgG had a slope of 1.45 and an intercept of 1.60 (Sy/x = 7.46, r = 0.96, n = 250); IgA had a slope of 1.30 and an intercept of -1.37 (Sy/x = 6.85, r = 0.96, n = 78); and IgM had a slope of 1.95 and an intercept of 2.06 (Sy/x = 5.16, r = 0.98, n = 128). The data for individual patients showed similar good correlations. Exceptions included IgA peaks "buried" in the beta region of the SPE (resulting in invalid SPE estimates of monoclonal protein concentration), and IgG peaks of less than 10 g/L (when background polyclonal IgG immunoglobulin skews the QIG estimate of monoclonal protein concentration). An algorithm is proposed whereby monoclonal protein concentration is measured by the specific QIG (i.e., IgG, IgA, or IgM) determination for the routine monitoring of patients, except for those with IgG peaks of less than 10 g/L that are followed by SPE.
Asunto(s)
Densitometría/estadística & datos numéricos , Nefelometría y Turbidimetría/estadística & datos numéricos , Paraproteinemias/diagnóstico , Electroforesis de las Proteínas Sanguíneas/economía , Electroforesis de las Proteínas Sanguíneas/normas , Densitometría/economía , Humanos , Inmunoglobulinas/sangre , Nefelometría y Turbidimetría/economía , Paraproteinemias/sangre , Paraproteinemias/economíaRESUMEN
In order to reduce the cost of a systematic heterozygote thalassemias screening, and using a discriminant analysis, the authors propose a pre-selection performed on the erythrocytometric data. In the present conditions of applicability, the methodology we used appears to be very efficient in the pre-screening process. An electrophoresis with the determination of hemoglobin A2 is then carried out on the pre-selected individuals as a confirmation of the diagnosis.
Asunto(s)
Talasemia/sangre , Adolescente , Electroforesis de las Proteínas Sanguíneas/economía , Recuento de Eritrocitos , Femenino , Salud Global , Hematócrito , Hemoglobinas/análisis , Heterocigoto , Humanos , Masculino , Talasemia/genéticaRESUMEN
Se platea una solución técnica al problema de cómo reducir la incidencia de la sicklemia en nuestro país, así como el riesgo a que están expuestos los portadores; por una identificación de estos últimos, y el consejo genético, en los casos de familias con "alto riesgo", hemos desarrollado un sistema de pesquisaje electroforético, el cual resulta suficientemente rápido, económico y seguro. El sistema incluye la colección de sangre capilar, y su hemólisis, la documentación de los datos del donante con una rapidez de aproximadamente 50-60 muestras por una persona, en una hora con un costo de cerca de $1,00 por cada 1 000 muestras, y el análisis electroforético, que incluye la documentación de los resultados en película fotográfica, el que puede ser realizado por una persona a una velocidad de 180 muestras en una hora con un costo de cerca de $1,2 por cada 1 000 muestras. Se utiliza el equipo en el análisis de otros polimorfismos(AU)
Asunto(s)
Humanos , Anemia de Células Falciformes/diagnóstico , Anemia de Células Falciformes , Costos de la Atención en Salud , Heterocigoto , Electroforesis de las Proteínas Sanguíneas/economía , Hemoglobinas/análisisRESUMEN
La electroforesis en papel de filtro, al simplificar y reducir el costo del procedimiento, permite determinar con facilidad el fraccionamiento de las proteínas plasmáticas, con una mínima cantidad de suero (0.1 e.e.) lo que facilita su estudio en el recién nacido y prematuro...(AU)