Description of the blood Analysis: 

Pseudocholinesterase (PChE) is an enzyme produced by the liver and found in the blood plasma. It is different from “Acetylcholinesterase,” which is found in nerve tissue and red blood cells. PChE’s primary job in clinical medicine is to break down specific chemicals, most notably succinylcholine and mivacurium—muscle relaxants commonly used during general anesthesia to allow for intubation and surgery.

What Does the Analysis Represent?

• Goal: To determine if a person can safely metabolize anesthesia or to check for exposure to certain toxins.
• Main Application: Identifying Pseudocholinesterase Deficiency (a genetic condition) and monitoring for organophosphate (pesticide) poisoning.
• Biological Process: It serves as a measure of the liver’s synthetic capacity and the body’s ability to clear specific drugs. If the enzyme level is too low, muscle relaxants that should last for minutes can paralyze a patient for hours.

Recommendations for the Test (General)

• Fasting: Not required, though often done as part of a pre-surgery panel.
• Stability: If testing for pesticide exposure, the sample should be taken as soon as possible after the suspected contact.
• Family History: If you or a relative had a “delayed recovery” or stayed on a ventilator longer than expected after surgery, you should take this test before any future procedures.
• Material: Venous blood (serum or plasma).

What Can Affect the Results?

• Genetics: Some people are born with an “atypical” form of the enzyme that doesn’t work well, even if the quantity is normal.
• Liver Disease: Since PChE is made in the liver, cirrhosis, hepatitis, or liver cancer will cause levels to drop.
• Pregnancy: Levels naturally decrease during pregnancy and for a few days after delivery.
• Malnutrition: Severe protein deficiency reduces the liver’s ability to produce the enzyme.
• Medical Conditions: Chronic kidney disease, severe infections, and certain cancers can lower levels.

When to Take the Test?

• Pre-Surgery Screening: If you have a family history of anesthesia complications.
• Post-Surgery Complications: If a patient experiences “prolonged apnea” (inability to breathe independently) after being given muscle relaxants.
• Pesticide Exposure: If you work with organophosphates or carbamates and experience symptoms like blurred vision, tremors, or excessive salivation.

How to Interpret the Results?

Important: Results must be reviewed by a medical expert, especially before any surgery involving anesthesia. Low Activity: Indicates a risk for prolonged muscle paralysis after certain anesthetic drugs or exposure to pesticides. High Activity: May be associated with obesity, diabetes, or nephrotic syndrome.

Possible Further Investigations

• Dibucaine Number: A follow-up test used to determine if the deficiency is a matter of quantity (low levels) or quality (the enzyme is there but doesn’t work).
• Acetylcholinesterase (RBC): Tested alongside PChE for a more complete picture of pesticide poisoning.
• Liver Function Panel (ALT/AST/Albumin): To see if low PChE is due to liver damage.

When Does the Next Step Make Sense? 

The next step is critical if you are scheduled for surgery and have a low result. You must inform your Anesthesiologist so they can choose alternative medications that do not require this enzyme for clearance. If the test was done for pesticide exposure, a low result requires immediate removal from the environment and potentially emergency treatment.

👉 If necessary, you can discuss the results of the analysis with a specialist, such as an Gastroenterologist (Doctors – TAMC)