No abstract

Providing interpretative comments on reports, particularly those for primary care physicians is an important part of our job. Few clinical biochemists (whether medical or scienti®c) receive signi®cant training for this. Most work in isolation, and few receive feedback on the utility of their comments. Surveys show an extremely wide divergence of opinion and comment even on apparently straightforward sets of abnormal results. Some comments are regarded as highly inappropriate when assessed by peer review. There is a need for further education and training in this area, concentrating as much on`how to comment' as on`what to comment'. There is also a need to establish some form of quality assurance for this important part of the post-analytical phase. A pilot External Quality Assurance Scheme (EQAS) is now being established.

Methods for separating free and antibody-bound hormone in radioimmunoassays for total triiodothyronine (T-3) and thyroxine (T-4) in unextracted human serum are evaluated. For T-3 assay, a simplified second antibody technique has significant advantages over other methods and gives a mean interassay coefficient of variation of 7.2% over a wide range of values. For T-4 assay, polyethylene glycol is the method of choice and has a mean interassay coefficent of variation of 4.7%. By adding the separating agents initially, the assays are readily semi-automated and may be completed within a working day.

SUMMARY. We have conducted a survey in the United Kingdom in order to evaluate the prevalence of anaemia and of iron deficiency in elderly male and female patients and in female patients of child-bearing age presenting to their general practitioner. Although haemoglobin values were approximately normally distributed, there was evidence of a bimodal distribution of serum ferritin values, particularly in elderly men. A correlation between serum ferritin and haemoglobin values was found to exist, both in the elderly and in younger women.The overall prevalence of anaemia in the study population was 14'3%, although it was higher for elderly men (20,1%) than either elderly women (13'7%) or women of child-bearing age (11'9%). Iron deficiency associated with anaemia was more common in elderly men (45,2% of those anaemic) than elderly women (28'6%) or women of child-bearing age (25'6%).This survey indicates that the prevalence of anaemia among certain groups of high risk patients presenting for consultation to their general practitioner is about 1 in 7, although the prevalence is as high as 1 in 5 in elderly men. Additional key phrases: ferritin; anaemia; general practiceAnaemia may be one of the more prevalent undiagnosed conditions in the community. Previous studies of haemoglobin concentrations have used random samples of the general population. H In these studies, the criteria for anaemia have ranged from a haemoglobin concentration below 12·5 to 13'Og/dL for men and 11·5 to 12·0g/dl, for women. Excluding pregnant women, the prevalence of anaemia was variously estimated as between 2·9% and 13·25% for men and 2·4% and 20·0% for women. Certain groups are thought to be at risk, specifically women of child-bearing age and the elderly.Serum ferritin concentrations correlate well with body iron stores, and can be used as indicators of iron deficiency or overload.':" Ferritin concentrations in women tend to be lower than in men, which is thought to reflect decreased iron stores through iron loss in menstruation.

I describe a comparatively simple method for assessing the quality of comments on clinical biochemistry reports. It is based on independent peer review of components of comments, appears reasonably robust and correlates well with separate independent assessment of the value of complete comments. The method gives a numerical score, and thus lends itself to a wide range of statistical manipulations and assessment for education and audit purposes.