University of Virginia case conference. Macroamylase, macro creatine kinase, and other macroenzymes.

Theimportanceofmacroenzymes hasbecomeincreasing-lyapparentinrecentyears(1,2).Macroamylase (EC3.2.1.1)andmacroCK(EC2.7.3.2)arethemacroenzymes mostcommonlynotedintheclinicallaboratory, andtheyarefrequentlyresponsible fordiagnosticconfusion.2Severalmethodsareavailablefortheconfirmation andanalysisofmacroenzymes, manyofwhichrequireexpensiveequipmentorcomplicatedtechniques.Inthisreportwesummarizetwocasesofmacrocreatinekinaseandtwocasesofmacroamylase thatillustrate theclinicalimportanceofrecognizingthesemacroenzymes. Wereviewthefeaturesofthesemacroenzymes, discusstheirlaboratoryevaluation,anddescribeasimplemethodthatwehaveusedtodetectthemacroenzymes inthese(andother)patientsatourinstitution. Finally,wereviewtheliterature onother,lesscommonlyobservedmacroenzymesinhumanblood.Westress(a)theimpactofmethodologyonclinicalimpressions and(b)theimportance ofdiscussinglaboratory observations withthepatient’sphysicianandcommunicating themtothepatient’smedicalrecordinwriting.

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