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Creatine Kinase (CK), MB and Total

CPT: 82550; 82553
Updated on 09/22/2020
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Synonyms

  • CK-2
  • CK-MB and Total CK

Test Includes

CK-MB isoenzyme quantitation; total CK


Special Instructions

State patient's sex on the test request form.

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.


Expected Turnaround Time

1 - 3 days


Related Documents


Specimen Requirements


Specimen

Serum


Volume

3 mL


Minimum Volume

0.6 mL (Note: This volume does not allow for repeat testing.)


Container

Red-top tube or gel-barrier tube


Storage Instructions

Refrigerate.


Stability Requirements

Temperature

Period

Room temperature

1 day

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3


Patient Preparation

CK is most commonly elevated in acute myocardial infarction (AMI) in which it has its greatest usefulness. Collection of specimen at onset of symptoms to establish baseline values is needed. A patient at onset of acute myocardial infarction (AMI) will have normal results, but some patients reach medical attention at or beyond CK peak. To support the diagnosis of AMI, three CK isoenzyme determinations have classically been recommended, one on admission, a second 12 hours after admission, a third 24 hours after admission. Another at 48 hours may be needed. CK-MB usually peaks between 15 and 20 hours after the onset of a myocardial infarction. Pappas summarizes current literature regarding timing as follows. In non-Q wave, incomplete occlusion, nontransmural MI, CK-MB peaks on the average 15 hours from onset. In Q wave (complete occlusion) (transmural) infarction, CK-MB average peak is 17 to 20 hours after onset of symptoms. He emphasizes the importance of a sample for CK-MB drawn 16 hours after onset.1 When increased CK-MB values have returned to normal, CK isoenzyme determinations are usually no longer required.


Causes for Rejection

Hemolysis; use of anticoagulants citrate or fluoride (they inhibit CK activity)


Test Details


Use

MB is the myocardial fraction associated with MI and occurs in certain other states. MB can be used in estimation of infarct size. MB increases have been reported with entities which cause damage to the myocardium, such as myocarditis, some instances of cardiomyopathy, and with extensive rhabdomyolysis, Duchenne muscular dystrophy, malignant hyperthermia, polymyositis, dermatomyositis, mixed connective tissue disease, myoglobinemia, Rocky Mountain spotted fever, Reye syndrome, and rarely in rheumatoid arthritis with high titer RF.2 CK-MB does not generally abruptly rise and fall in such nonacute MI settings, as it does in acute myocardial infarct (AMI).


Limitations

Triglycerides >300 mg/dL will cause >20% loss of CK-MB activity. Exercise, intramuscular injections, myxedema, grand mal seizures, prior trauma or surgery and acute MI very early or late lead to the combination of increased total CK but usually normal CK-MB. Increased CK-MB has been described in marathon runners without MI.3 CK isoenzyme analysis is not usually practical when the total CK is very low, although in elderly people with low muscle mass, the use of sensitive mass concentration assays may be useful. A single CK isoenzyme examination may be misleading. One should look for a pattern in serial CK isoenzyme analyses and seek confirmation with the isoenzymes of LD (LDH), ideally beginning with onset to establish the baseline. LD isoenzyme 1:2 flip is most consistently found about two days after onset of acute infarction of myocardium. The diagnosis of myocardial injury should not be based solely on MB isoenzyme, but rather should be supported by clinical findings, ECG, and often other laboratory parameters (ie, confirmation by LD isoenzymes).1


Methodology

CK total: kinetic, 340 nm spectrophotometric; CK-MB: immunochemiluminometric assay (ICMA)


Reference Interval

See tables.

Total CK (U/L)

Age

Male

Female

0 to 7 d

59-1111

55-777

8 to 30 d

51−168

37−151

1 m to 1 y

57−301

50−263

2 to 12 y

53−229

45−198

13 to 17 y

53−446

32−182

18 to 50 y

49−439

32−182

51 to 80 y

41–331

32–182

>80 y

30–208

26–161

CK-MB (ng/mL):

Male: 0.0–10.4

Female: 0.0–5.3

See table.

Age

Male (U/L)

Female (U/L)

0 to 7 d

59−1111

55−777

8 to 30 d

51−168

37−151

1 m to 1 y

57−301

50−263

2 to 12 y

53−229

45−198

13 to 17 y

53−446

32−182

18 to 50 y

49−439

32−182

51 to 80 y

41–331

32–182

>80 y

30–208

26–161

• CK-MB: Male: 0.0−10.4 ng/mL, female: 0.0−5.3 ng/mL

See tables.

Total CK (U/L)

Age

Male

Female

0 to 7 d

59-1111

55-777

8 to 30 d

51−168

37−151

1 m to 1 y

57−301

50−263

2 to 12 y

53−229

45−198

13 to 17 y

53−446

32−182

18 to 50 y

49−439

32−182

51 to 80 y

41–331

32–182

>80 y

30–208

26–161

CK-MB (ng/mL):

Male: 0.0–10.4

Female: 0.0–5.3


Additional Information

CK-MB is usually not elevated in exercise (total CK elevated); myxedema (total CK elevated in about half of cases); injections into muscle (total CK elevated); strokes, CVA, and other brain disorders in which total CK may be increased; pericarditis; pneumonias or other lung diseases; pulmonary embolus; seizures (CK may be very high but no great MB increase, if any). Although CK-MB is not usually increased in angina, some CK-MB elevations are recognized in angina patients, depending partly on laboratory methodology.


Footnotes

1. Pappas NJ Jr. Enhanced cardiac enzyme profile. Clin Lab Med. 1989 Dec; 9(4):689-716. 2686909
2. Wolf PL. Common causes of false-positive CK-MB test for acute myocardial infarction. Clin Lab Med. 1986 Sep; 6(3):577-581. 3742986
3. Siegel AJ, Silverman LM, Evans WJ. Elevated skeletal muscle creatine kinase MB isoenzyme levels in marathon runners. JAMA. 1983 Nov 25; 250(20):2835-2837. 6644963

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
002311 Creatine Kinase (CK), MB/Total 001362 Creatine Kinase,Total U/L 2157-6
002311 Creatine Kinase (CK), MB/Total 120817 Creatine Kinase (CK), MB ng/mL 13969-1

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