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Test Catalog

Test ID: PCHE1    
Pseudocholinesterase, Total, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Monitoring exposure to organophosphorus insecticides

 

Monitoring patients with liver disease, particularly those undergoing liver transplantation

 

Identifying patients who are homozygous or heterozygous for an atypical gene and have low levels of pseudocholinesterase

 

This tests is not useful for the differential diagnosis of jaundice.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Serum cholinesterase, often called pseudocholinesterase (PCHE), is distinguished from acetylcholinesterase or "true cholinesterase," by both location and substrate.

 

Acetylcholinesterase is found in erythrocytes, in the lungs and spleen, in nerve endings, and in the gray matter of the brain. It is responsible for the hydrolysis of acetylcholine released at the nerve endings to mediate transmission of the neural impulse across the synapse.

 

PCHE, the serum enzyme, is also found in the liver, the pancreas, the heart, and in the white matter of the brain. Its biological role is unknown.

 

The organophosphorus-containing insecticides are potent inhibitors of the true cholinesterase and also cause depression of PCHE. Low values of PCHE are also found in patients with liver disease. In general, patients with advanced cirrhosis and carcinoma with metastases will show a 50% to 70% decrease. Essentially normal values are seen in chronic hepatitis, mild cirrhosis, and obstructive jaundice.

 

PCHE metabolizes the muscle relaxants succinylcholine and mivacurium, and therefore, alterations in PCHE will influence the physiologic effect of these drugs.

 

In normal individuals (approximately 94% of the population) certain drugs and other agents, such as dibucaine and fluoride, will almost completely inhibit the PCHE activity.

 

A small number of individuals (<1% of the population) have been shown to have genetic variants of the enzyme, and therefore, cannot metabolize the muscle relaxants succinylcholine and mivacurium and experience prolonged apnea. These individuals generally have low levels of PCHE, which is not inhibited by dibucaine or fluoride. These individuals are either homozygotes or compound heterozygotes for an atypical gene controlling PCHE.

 

Simple heterozygotes have also been identified who show intermediate enzyme values and inhibition.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Males

5320-12,920 U/L

Females

0-15 years: 5320-12,920 U/L

16-39 years: 4260-11,250 U/L

40-41 years: 5320-12,920 U/L

> or =42 years: 5320-12,920 U/L

Note: Females age 18-41 years who are pregnant or taking hormonal contraceptives, the reference interval is 3650-9120 U/L.

Interpretation Provides information to assist in interpretation of the test results

Patients with normal pseudocholinesterase (PCHE) activity show 70% to 90% inhibition by dibucaine, while patients homozygous for the abnormal allele show little or no inhibition (0%-20%) and usually low levels of enzyme.

 

Heterozygous patients have intermediate PCHE levels and response to inhibitors.

 

The atypical gene is inherited in an autosomal recessive pattern. In a positive patient, family members should be tested.

 

Decreasing or low levels may indicate exposure to organophosphorus insecticides, as long as liver disease and an abnormal allele have been ruled out.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

There are some homozygous and heterozygous individuals who are sensitive to succinylcholine although their total pseudocholinesterase (PCHE) values are normal. A dibucaine inhibition test is necessary to confirm the presence of the abnormal allele in these individuals.

 

Certain drugs and anesthetic agents may produce in-vitro inhibition of the PCHE activity. Therefore, it is recommended that blood specimens be drawn 24 to 48 hours post-operatively on those patients who have experienced prolonged apnea after surgery.

 

Chemotherapy may interfere with test results, depending on the impact it has on the liver. PCHE levels may be lower due to this and if so, testing should be repeated at a later date.

 

Method Change: Pseudocholinesterase values measured after 1-28-2020 are approximately 80% increased compared to historical values and should be interpreted in the context of the current reference interval.

 

In very rare cases of gammopathy, in particular type IgM (Waldenstrom macroglobulinemia), may cause unreliable results.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Soliday FK, Conley YP, Henker R: Pseudocholinesterase deficiency: A comprehensive review of genetic, acquired, and drug influences. AANA J. 2010;78:313-320

2. Robles A, Michael M, McCallum R: Pseudocholinesterase deficiency: What the proceduralist needs to know. Am J Med Sci. 2019 Mar;357(3):263-267. doi: 10.1016/j.amjms.2018.11.002

3. Lurati AR: Organophosphate exposure with pseudocholinesterase deficiency. Workplace Health and Saf. 2013 Jun;61(6):243-245. doi: 10.1177/216507991306100602

4. den Blaauwen DH, Poppe WA, Tritschler W: Cholinesterase (EC 3.1.1.8) with butyrylthiocholine-iodide as substrate: References depending on age and sex with special reference to hormonal effects and pregnancy. J Clin Chem Clin Biochem. 1983;21:381-386