Dibucaine Number With Serum and RBC Cholinesterase

CPT: 82480; 82482; 82638
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Test Details

Synonyms

  • Cholinesterase Inhibition by Dibucaine
  • Pseudocholinesterase Inhibition

Test Includes

Dibucaine number with serum and RBC cholinesterase

Use

Assess the presence of homozygous or heterozygous “atypical” cholinesterase variant, in patients who have low result of serum or plasma cholinesterase assay, and may be at risk of apnea when given succinylcholine muscle relaxant.

Limitations

No single simple test currently exists that can detect all enzyme variants.

Methodology

Cholinesterase by spectrophotometry (Ellman) with dibucaine inhibition

Additional Information

The degree of serum or plasma cholinesterase inhibition produced by dibucaine is under genetic control. Sensitivity to succinyl choline is dependent upon at least four allelic genes. The total quantitative cholinesterase determination may not be reliable in detecting sensitivity to succinyl choline as variant enzymes exhibit qualitative and quantitative differences in substrate specificity.

The dibucaine number indicates the percent inhibition of enzyme activity by this agent when a serum or plasma sample is tested under standard conditions (inhibition expressed as a percent). This approach to detection of serum or plasma cholinesterase variants does not entirely avoid the problem of variation in reactivity with some atypical enzymes. Prolonged apnea following hemodilutional cardiopulmonary bypass has been reported in a patient whose admission (preoperative) plasma cholinesterase level was slightly below the normal range.1

Specimen Requirements

Specimen

Serum and whole blood

Volume

2 mL serum and 5 mL whole blood

Minimum Volume

0.1 mL serum and 1 mL whole blood

Container

Red-top tube, gel-barrier tube, and lavender-top (EDTA) tube

Patient Preparation

Do not collect within 24 hours of administration of muscle relaxant.

Collection

Separate serum from cells in red-top tube and place in transport tube marked “serum.” Do not separate EDTA tube.

Storage Instructions

Room temperature. Whole blood (RBC): Stable at room temperature or refrigerated for 14 days and unstable frozen. Serum: Stable at room temperature, refrigerated, or frozen for 14 days; freeze/thaw cycles: stable x3.

Causes for Rejection

Serum not separated from cells; serum and whole blood specimens not sent; anticoagulants other than EDTA (RBC only); frozen whole blood received; hemolyzed serum

Clinical Information

Footnotes

1. Jackson SH, Bailey GW, Stevens G. Reduced plasma cholinesterase following haemodilutional cardiopulmonary bypass. Anaesthesia. 1982 Mar; 37(3):319-321.7091605

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
121152 Dibucaine, S/RBC Cholines. 081513 Dibucaine Number % inhibition 39354-6
121152 Dibucaine, S/RBC Cholines. 121153 Cholinesterase, S U/L 2098-2
121152 Dibucaine, S/RBC Cholines. 081539 Cholinesterase,RBC U/L 2099-0
Reflex Table for Dibucaine Number
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 081756 Disclaimer: 081756 Disclaimer: N/A

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The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf