Best practice in primary care pathology: review 5

Abstract

This fifth best practice review examines three series of common primary care questions in laboratory medicine: (1) minor liver function test abnormalities; (2) laboratory monitoring of patients receiving lithium; and (3) investigation of possible venous thromboembolism. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus-based rather than evidence-based. They will be updated periodically to take account of new information.

Interpreting an isolated raised serum alkaline phosphatase level in an asymptomatic patient

“…If vitamin D levels are in the normal range and the serum ALP level is less than 1.5 times the upper reference limit, then observation of the patient should be continued, with further investigations if patients develop symptoms. 4 It is questionable whether the absence of symptoms in the presence of non-hepatic serum ALP levels more than 1.5 times the upper reference limit should be investigated further, 15 but bone scintigraphy may be considered in patients who are vitamin D replete to identify asymptomatic Paget's disease, as some 12 but not all 13 suggest that this is an indication for active treatment.…”

Best practice in primary care pathology: review 6

“…Answers to the first four question answer sets can be found in Smellie et al [84][85][86][87][88] They have all used a common search method, 89 although in instances where recent systematic reviews have been performed, the guidance also relies heavily on the findings of these reviews. Authors wishing to consult the UK General Medical Services Contract and the current Quality and Outcomes Framework guidance can find these on their respective websites.…”

Best practice in primary care pathology: review 9

“…Answers to the first 8 question-and-answer sets can be found in eight previously published references. [65][66][67][68][69][70][71][72] They have all used a common search methodology 73 , although where recent systematic reviews have been performed, the guidance also relies heavily on the findings of these reviews. For authors wishing to consult the UK General Medical Services Contract and related quality and Outcomes framework, these can be found in previous published references.…”