title: State-wide hospital clinical laboratory plan for measuring cholinesterase activity for individuals suspected of exposure to nerve agent chemical weapons.
abstract: BACKGROUND
  Hospital laboratories currently lack the capacity to provide emergency determination of cholinesterase activity.
  
  
  METHODS
  We have developed a hospital-based 3-tiered system to test plasma for butyrylcholinesterase (BChE) activity and whole blood for red cell acetylcholinesterase (AChE) activity using available technology and personnel. Interagency communications, toxidrome definition, and patient triage will be coordinated by the Connecticut Department of Public Health and the Poison Control Center.
  
  
  METHODS
  Initial BChE data documents good precision between institutions (coefficient of variation < 8%).
  
  
  CONCLUSIONS
  Laboratory testing of plasma or blood for cholinesterase activity is important in the management of nerve agent exposure and in ruling out disease in those with non-specific symptoms in the setting of a terrorist attack or accidental exposure. Rapid availability of strong hospital-based analytic support in a smoothly functioning network of clinical, public health, and laboratory services will facilitate overall regional response to chemical terrorism or large scale HazMat events.
authors.affiliation: Department of Laboratory Medicine, University of California, San Francisco, CA 94110, USA. wualan@labmed2.ucsf.edu
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.forename: Robert
authors.initials: R
authors.lastname: McComb
authors.forename: George N
authors.initials: GN
authors.lastname: Bowers
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Makowski
authors.forename: Charles A
authors.initials: CA
authors.lastname: McKay
authors.forename: Jason
authors.initials: J
authors.lastname: Vena
authors.forename: John
authors.initials: J
authors.lastname: McDonagh
authors.forename: Sidney
authors.initials: S
authors.lastname: Hopfer
authors.forename: Salvatore F
authors.initials: SF
authors.lastname: Sena
authors.forename: Herbert
authors.initials: H
authors.lastname: Malkus
authors.forename: Elaine
authors.initials: E
authors.lastname: Forte
authors.forename: Katherine
authors.initials: K
authors.lastname: Kelly
mesh_terms: D000110:Acetylcholinesterase / Q000097:blood; D002091:Butyrylcholinesterase / Q000097:blood*; D002619:Chemical Warfare Agents / Q000032:analysis* / Q000506:poisoning; D019411:Clinical Laboratory Techniques / Q000379:methods*; D003237:Connecticut; D004784:Environmental Monitoring / Q000379:methods; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D004912:Erythrocytes / Q000201:enzymology; D006801:Humans; D019570:Inhalation Exposure; D007755:Laboratories, Hospital / Q000458:organization & administration / Q000592:standards; D010865:Pilot Projects; D011041:Poisoning / Q000097:blood / Q000201:enzymology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D023481:Terrorism / Q000517:prevention & control
chemical_list: D002619:Chemical Warfare Agents; D000110:Acetylcholinesterase; D002091:Butyrylcholinesterase