[Macro creatine kinase: illness marker. Practical guide for the management].
OBJECTIVE
The Macro creatine kinase (Macro-CK) is a complex constituted by polymerization of isoenzymes of creatine kinase (CK-BB or CK-MM together with IgG in the type I and oligomers of CK mitochondrial in the type II). Their presence in plasma generates false elevations of the CK-MB isoenzyme, upon interfering with the techniques of imunoinhibition used in the emergency room laboratories, what it constitute a serious problem in the diagnosis of squares of myocardial ischemia. The ignorance of this clinical situation has pushed us to present this study in order to begin to consider their utility like marker of illness, giving shortly, some recommendations for the correct management of this discovery in the emergency.


METHODS
They have been studied the total of patients valued in the emergency for 16 months that they gathered this requirements (25), valuing the pathology that appeared under this analytic determination. The identification of the isoenzymes of CK was carried out by means of agarose gel electrophoresis.


RESULTS
The 13 cases with Macro-CK type I (9 women and 4 males) had a half age of 64 years (4-89). The levels means of CK were 274 mU/mL with a CK-MB of 440 U/L (166%). The 7 cases with Macro-CK type II (1 woman and 6 males) had a half age of 69 years (32-80). The levels means of CK were 314 mU/mL with a CK-MB of 569 U/L (191%). The 53.8% of the patients with Macro-CK type I presented any cardiovascular pathology, the 38.5% diabetes mellitus and the 30.8% pathology muscle-articulate with possible component autoimmune. The 100% of the patients with Macro-CK type II suffered processes malignant tumors, highlighting the presence of tumors of digestive origin and prostatic, with metastasis, being the more frequent in liver and bone (71.4%), and a high mortality of the 71.4% (5 deaths). The Macro-CK type II (form oligomer of mitochondrial) is liberated like consequence of a lesion of the mitochondrias of the affected fabrics tissues, associating to serious illnesses like cirrhosis and tumors.


CONCLUSIONS
In all the studied cases the payees of Macro-CK presented underlying pathology, being in the case of Macro-CK type I of heart prevalence, and in the case of type II of nature tumoral. A management Macro-CK algorithm is also presented for the emergency.
Ruiz Ginés
M A
MA
Servicio de Análisis Clínicos y Bioquímica, Hospital Virgen de la Salud de Toledo, Complejo Hospitalario, Toledo. mangelrg@sescam.jccm.es
Calafell Mas
M F
MF
Ruiz Ginés
J A
JA
Fernández Rodríguez
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000201:enzymology; D002648:Child; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000175:diagnosis / Q000201:enzymology; D009369:Neoplasms / Q000175:diagnosis / Q000201:enzymology; D012189:Retrospective Studies
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase