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NEWSLETTER ISSUE - 26th JULY 2021 
 

CHANGE FROM AMYLASE TO LIPASE TESTING 


From 1 August 2021, serum lipase will replace pancreatic amylase as a more specific test for routine investigation of suspected acute pancreatitis.


In Wellington, pancreatic amylase has traditionally been used as the diagnostic test for acute pancreatitis. Many other pancreatic and non-pancreatic (intra- and extra-abdominal) conditions for which amylase is generally not the test of choice for diagnosis and monitoring however, can also be associated with elevated serum amylase levels e.g. pseudo-cysts, perforated bowel, mesenteric infarction, intestinal obstruction, appendicitis,  peritonitis, ruptured ectopic pregnancy, fallopian/ovarian cysts, salpingitis, hepatitis, pneumonia, acute pulmonary oedema and diabetic ketoacidosis.
 
For the diagnosis of acute pancreatitis, serum lipase offers better diagnostic value compared to serum amylase due to its superior specificity, greater sensitivity, longer half-life and hence larger diagnostic window in patients who present late or have alcoholic pancreatitis.
 
There is no role in following the serial trend of lipase (or amylase) on a daily basis in patients with acute pancreatitis once the diagnosis has been established. It is also not useful for monitoring clinical improvement in the short term. If the initial presentation is within 4-5 hours of the onset of abdominal pain and if the initial level of lipase is normal, it may be worthwhile to repeat the lipase in the next couple of hours if the clinical suspicion of acute pancreatitis is high. If the patient continues to have pain or symptoms weeks after the presentation, checking a repeat lipase level may be useful, as an elevated level can signify persistent pancreatic inflammation, pancreatic duct obstruction or pseudocyst, although imaging (MRI or CT) is still more sensitive and specific in these instances and the tests of choice.

For situations where amylase is still the appropriate or required test, please request total amylase and provide supporting clinical details, otherwise lipase will be performed instead. Please note that co-ordering of both amylase and lipase has shown little to no increase in diagnostic sensitivity and specificity.

Routine analysis of fluid for total amylase will be available at Wellington SCL.
 
 
Dr Melissa Yssel
Chemical Pathologist
Wellington SCL

HISTOLOGY REPORTING DELAY

 

WSCL currently has an increased turnaround time for histology specimens as a result of some increase in volume and a temporary shortage of pathologists.  We appreciate your patience while we work through the backlog of samples.
 


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Riddiford Street, Newtown
Wellington, Wgn 6011
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Awanui Labs - Wellington · Level 5, CSB Block · Riddiford Street, Newtown · Wellington, Wgn 6011 · New Zealand

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