SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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B SURINA1 , Z SIFTAR1 , Z FLEGAR-MESTRIC1 , V SIMEON-RUDOLF2

1Institute of Clinical Chemistry, University Hospital, Zagreb, Croatia, 2Institute for Medical Research and Occupational Health, Zagreb, Croatia

Objective. Recognition of butyrylcholinesterase (BChE, EC 3.1.1.8) variants in human serum is essential to identify patients who may be suspectible to a prolonged reaction of suxamethonium and mivacurium, short-acting muscle relaxants. Therefore, a Cholinesterase Unit for detection of individuals, carriers of inherited suxamethonium sensitive butyrylcholinesterase variants was established at the Institute for Clinical Chemistry, University Hospital, Zagreb, Croatia.
Patients and methods. Summarizing all our results obtained on the Croatian population, we examined 1545 individuals and 8 families of the patients who were carriers of atypical or other suxamethonium sensitive BChE phenotypes. BChE activity was measured in sera with 7,0 mM butyrylthiocholine as substrate according to the spectrophotometric method by Das and Liddell using the Herbos diagnostics kit (Herbos, Sisak, Croatia). Phenotyping of BChE was done by measuring the inhibition of butyrylthiocholine hydrolysis by dibucaine, sodium fluoride, urea or Ro 02-0683 (dimehylcarbamate of (2-hydroxy-5-phenyl-benzyl)-trimethylammonium bromide). Results. Our results showed that 93% of 1545 individuals, possessed the usual enzyme. The frequency for UA, UF, AK, AA, US, AF, FF and AS phenotypes was 4,8; 1,5; 0,32; 0,32; 0,19; 0,13; 0,065 and 0,065, respectively. We examined 8 families: 4 of UA and 2 of AS, and 1 of US and AA carriers. So far, we have issued «Warning Card» to persons assigned as UA and AK, and in the third case to the AS phenotype carrier. Conclusion. Once established, the phenotype of BchE does not change during the lifetime. Therefore, early detection of this genetic abnormality is very important for patients undergoing a surgical procedure. The carriers of an abnormal phenotype of BChE receive a «Warning Card» as a permanent warning against succinylcholine administration as well as a warning to the members of the their families to test their own phenotype of BChE.

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