Low value biochemistry tests

The Canadian Society of Clinical Chemists has released the following ten new recommendations of tests, treatments or procedures to question in clinical biochemistry: 

1. Don’t order HFE-related hemochromatosis molecular testing unless BOTH the ferritin (above upper limit of normal), and the transferrin saturation (above 45%) are elevated.
2. Don't repeat HbA1c testing within 3 months of a previous result.
3. Don’t order tissue transglutaminase IgG antibody or Deamidated Gliadin Peptide (DGP) antibody testing in the initial screening for Celiac Disease.
4. Don’t repeat renal calculi analysis within 3 years.
5. Don’t order random urine protein electrophoresis to screen for a monoclonal gammopathy.
6. Do not routinely order iron profile (iron, UIBC/TIBC, transferrin saturation) in the investigation of iron deficiency. A low ferritin result is highly probable for iron deficiency, and thus, there is no added value in performing an iron profile.
7. Do not order AST or Urea for routine screening in the initial workup of common diagnostic investigations. Review order sets regularly for diagnostic utility and uncouple low value routine tests (i.e. AST and ALT).
8. Do not routinely order both total and direct bilirubin testing on patients.
9. Do not routinely order urine drug screens for evaluation of patients with substance use disorders (1) without a clinical care plan directed by the test results, (2) without laboratory input, especially on the ability of immunoassay results to support the clinical management.
10. Don’t order allergen specific IgE (sIgE) tests unless indicated by the patient’s clinical history and correlated to specific exposures.

See the full list for the rationale and references for each recommendation. 

Feel free to question / argue / let us know if you and your department are already avoiding these tests and any advice on implementing the change!