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Best practice in primary care pathology: review 5
  1. W S A Smellie1,
  2. J Forth2,
  3. S Ryder3,
  4. M J Galloway4,
  5. A C Wood5,
  6. I D Watson6
  1. 1Department of Chemical Pathology, Bishop Auckland General Hospital, Durham, UK
  2. 2Sowerby Centre for Health Informatics, Bede House, All Saints Business Centre, Newcastle upon Tyne, UK
  3. 3Department of Gastroenterology, Queen’s Medical Centre, Nottingham, UK
  4. 4Department of Haematology, City Hospitals Sunderland NHS Trust, Sunderland Royal Hospital, Sunderland, UK
  5. 5Department of Haematology, James Cook University Hospital, Teesside, UK
  6. 6Department of Clinical Biochemistry, University Hospital Aintree Liverpool, UK
  1. Correspondence to:
 W S A Smellie
 Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK;info{at}


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.

  • ALP, alkaline phosphatase
  • ALT, alanine aminotransferase
  • AST, aspartate transaminase
  • BNF, British National Formulary
  • DVT, deep venous thrombosis
  • GGT, γ-glutamyl transpeptidase
  • GMS, General Medical Services
  • NAFLD, non-alcoholic fatty liver disease
  • ULN, upper limit of normal

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  • Published Online First 19 May 2006

  • Competing interests: None declared.