OT: Blood Tests

[Alexis]

Lemmy didn?t.

[Dave Plowman (News)]

Absolutely nothing unusual about those addicted to any drug claiming they're not. And/or claiming it has had no effect on their health.

[Andrew]

You aren't an alcoholic until you drink more than your GP.

[Dave Plowman (News)]

Best had a liver transplant and still died young.

[Dave Plowman (News)]

It's what many do. Alcoholics do lots of illogical things.

[Andrew]

In years gone by, most 'normal' values were established by testing medical students. It took years to establish a better picture of acceptable ranges, and this was done well before NHS labs were computerised.

[Andrew]

GGT 5-85 iu/l A.S.T. 5-40 iu/l A.L.T. 5-36 iu/l Alkaline Phosphatase 25-130 iu/l Albumin 35-50 Bilirubin 2-26 umol/l

Some people have permanently elevated bilirubin which gives them very slightly yellowy tinged eyes, but doesn't do any harm.

[polygonum]

It is still not satisfactory. For one particular test a typical range might be quoted as 0.4 to 4.5. But anyone with a test result of 2.5 or over is actually very likely to be suffering. (A tiny number of "healthy" people do have results between 2.5 and 4.5 - but it really is a small percentage.) The distribution is very much not normal/Gaussian but is treated is if it were.

And the guidelines say not to treat until the test result is over 10.0. On the basis of no proper research.

It is only over the past few years that labs have really started to ensure that the range-setting subjects are actually free of disease - especially the ones being tested for.

The ranges also vary from lab to lab which can make comparison awkward. For one thing, that means we always need a reference range to be quoted that was valid for the specific lab at the specific date. But many records do not include the reference ranges!

[polygonum]

Those could well be the reference ranges for the lab you are quoting. Another lab most definitely is not the same - and it has separate ranges for M & F. I'll just quote GGT:

Gamma glutamyl transferase male: 10 - 71 IU/L female: 6 - 42 IU/L

Varying ranges, whilst understandable, are a hazard in medicine.

[polygonum]

Assume you are nit suffering from auto-brewery syndrome?

(Has appeared several times recently in the media including Holby!)

[Andrew]

All UK pathology labs (including the ones run by charities) now adhere to national quality controls and standards and the analysers (thanks to digital electronics and computers) are now pretty well standard across the UK.

There was a problem with biochemistry results back in the 70's when I was a lab technician, because they could vary widely from hospital to hospital. It was less of a problem with haematology because virtually every lab used control samples from Coulter electonics, so either they were all right, or all wrong, or their regular bleaching, cleaning schedules were a bit amiss. Getting an accurate platelet count back in the 70's was a problem for even a certain teaching hospital in London. This was because they weren't using their Autotechnicon platelet counter properly :-), an issue which we at Barts were well aware of.

[michael adams]

From visitors.

In London 35% of households are single person. Which presumably includes quite a lot of single professional people, for a start.

The need to impress visitors is possibly one of the reasons why some people at least, choose not to live in absolute squalor.

michael adams

...

[Dave Plowman (News)]

Yup. Even although they may not have any. Just in case. Same reason they will use different places to buy their booze - just in case a checkout person might note how often they are buying booze. It is classic alcoholic behaviour - as anyone who has studied it (or experienced it) would know.

But many alcoholics do. Never clean the place or keep it tidy. But hide bottles.

[polygonum]

It is simply not the case that there are national standards for all lab tests - neither the units nor the ranges. Were that the case, we would not need pathology harmony:

They only claim standardisation for FBC (one of the most frequent sets of blood tests) from 2013. And that is just the units - not the reference ranges.

Though I accept that they all have to adhere to quality standards which are nationally set. I am advised by my tame lab test developer that some tests are very much less good than others for clear scientifically explainable reasons. One I can give you straight off is the possibility of antibody interference. Some tests are pretty much immune to interference whereas others are most definitely susceptible. The effect of the result can be very significant - but the cause would often be missed (and hence, misinterpreted) by medics.

"By 31st March 2013 units for reporting FBC should be standardised including the Haemoglobin level and MCHC as g/L"

GGT ( ? 7 ? 33 IU/L; ? 11 ? 51 IU/L)

GGT GAMMA GLUTAMYL TRANSFERASE (GGT) F ( 0 - 31 ) M ( 0 - 58 ) iu/L

Gamma-Glutamyl aminotransferase (GGT) Reference Range ? 0 ? 50 U/L ? 0 ? 32 U/L

In my particular area of interest, which is not liver, I see that though the units are (mostly) standardised, the ranges are very far from. Regularly we see ranges where the top of the range for one lab is only just above the bottom of the range for another lab.

[Cursitor Doom]

'Cos Dave said so and he gets really cross if anyone disagrees.

[Dave Plowman (News)]

That was one classic example I heard of. A widower neighbour of my mother. Two garden sheds crammed full of empty gin bottles. And kept locked.

[Dave Plowman (News)]

I merely said it was common behaviour with alcoholics. If you have evidence to the contrary, please give it.

If you know anyone who was a true alcoholic - ie one who has likely had help with it at some time, medical, AA, etc, ask their nearest and dearest. Although they may not want to discuss such things fully with anyone.

[Cursitor Doom]

Perhaps she just kept a bottle collection, FFS. Plenty of people do, you know.

[michael adams]

A classic instance of significance bias.

You've only remembered it at all because of the person keeping two locked sheds full of the same kind of stuff. Which is a very unusual occurrence in its own right; borderline eccentric in fact. And so something you'd most likely remember no matter what was in the sheds.

Whereas the people who've succeeded in hiding their empties all their lives, even beyond the grave, is by definition unknown.

So not a very good example there, I'm afraid.

michael adams

...

[Dave Plowman (News)]

No. Just an example from personal knowledge. Unlike all the 'what ifs' from most on here.

Given the period of time he'd collected them after his wife died, it was rather obvious he'd been drinking a great deal. His married daughter did visit regularly and knew he was drinking more than once was the case, but only discovered all the bottles after he died, on clearing the house.

Well, if I were to generalise, most alcoholics aren't going to travel far to conceal bottles. They just hide them round the house.

Really, if you want to find out typical alcoholic behaviour, have a chat to a councillor dealing with such things. But there will be plenty you'd find out from Google, etc.

The even odder thing is many alcoholics think they have invented this sort of behaviour, and it comes as a surprise to them that others do just the same.