Uso de valores de referências individualizados como ferramenta de auxílio diagnóstico

Abstract

The reference values range used currently are very wide. Sometimes the patient results may be altered, even when they fall inside those values. Using the Biological Variation as base, those results may have significant variation, without being noticed by the patient’s physician. To minimize those problems, some authors indicate the reference change values’ (RCV) use, that is a tool based in the Biological Variation and the Analytical Variation. Which verify the significance differences between two results at different times. This way the doctor may notice any change regarding the previous result, doing a decision-making based on the individualized attribute. It can also be used by physician that is following their patient throughout their treatment, to see if any change has occurred either for improvement or for looseness. It had been applied the formula: RCV=Zp(2)1/2(CVa2+CVi2)1/2, where Zp, is the standard deviation, for a error probability (1,96 or 2,98), Cva for analytical coefficient of variation, Cvi, for individual coefficient of variation. The formulation must be used for each analyte and in each sequential sample interval.With the objective of propose the change in the regular reference values, used at Clinical Pathology Service (Capsula) at Piquet Carneiro Policlinica, and the new way to evaluate the results released, helping the decision taking by the physicians and the laboratory staff. It had been created two process flows of results analyzes, comparing the results with de ones before. It had been analyzed of 83 patients from January of 2014 to December of 2016 of the analytes ALT, AST, GGT, alkaline phosphatase, urea and creatinine. Each patient presents at least 8 visits. More then 3900 results had been analyzed in search of improvements in the way of result releasing by the Capsula team mora agility. The individual biological variation, is the determinant of the use of the tool. Values outside this range often go unnoticed by the physician and analysis team, compared to the reference value, corroborating the use of the tool.