Evolution of clinical enzyme tests. 3. Phospholipase A.
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Lactate dehydrogenase (LD) activities are measured by the Japanese Society of Clinical Chemistry (JSCC) recommendation method (lactate to pyruvate direction). LD exists in a tetrameric form by the combination of M(A) and H(B) subunits. The quantitative distribution of the LD isozymes is different and characteristic. Therefore, LD activities and isozyme patterns are applied to laboratory diagnosis. However, the serum LD isozyme pattern is often modified by the differing elimination rates of each isozyme, and is sometimes modified by various other factors, such as LD-immunoglobulin complex, genetic variants, or tumor producing LD.
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With the advent of much more precise laboratory equipment, the use of performance-based standard deviations for enzymes, e.g. those based on the precision of the laboratory during a period of "satisfactory performance", is not appropriate; it leads to overly rigid precision limits and unnecessary repeat assays, and is wasteful of resources. Testing for the commonly used serum enzymes does not require tight precision given how enzyme data are viewed by most clinicians. Other ways to set process control limits all have some arbitrary content; however, this need not prevent their use. Laboratorians must choose the approach that is appropriate for their laboratory and medical staff to meet medically perceived needs.
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Clinical Enzymology is an important discipline of Clinical Chemistry and Laboratory Medicine. We review the significant aspect of clinical enzymology from the theoretical as well as the empirical points of view.
The traceability chains of the enzyme measurement system were established based on technological advances in instrumentation and reagent systems. The values assigned in reference materials (Japan Certified Enzyme Reference Materials; JCERM) were transferred to daily laboratory analysis via enzyme calibrators included in industrial reagent kits. The imprecision between laboratories was then minimized to within 4 percent in six enzymes, AST, ALT, LD, ALP, CK and gamma-GT.
Enzyme linked immunoglobulins, tumor production enzymes, alloenzymes (LD, CK, Cholinesterase) were explained by the genetic variants for their characterization and clinical significance. A recent interesting report on enzyme linked immunoglobulins, stated that there is a beta-sheet structural anomaly in Bence Jones protein which combines with LD and that macrolipase results from the combination of lipase and alpha 2-macroglobulin in hyperlipasemia.
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