State-wide hospital clinical laboratory plan for measuring cholinesterase activity for individuals suspected of exposure to nerve agent chemical weapons.
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.
Wu
Alan H B
AH
Department of Laboratory Medicine, University of California, San Francisco, CA 94110, USA. wualan@labmed2.ucsf.edu
Smith
Andrew
A
McComb
Robert
R
Bowers
George N
GN
Makowski
Gregory S
GS
McKay
Charles A
CA
Vena
Jason
J
McDonagh
John
J
Hopfer
Sidney
S
Sena
Salvatore F
SF
Malkus
Herbert
H
Forte
Elaine
E
Kelly
Katherine
K
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
D002619:Chemical Warfare Agents; D000110:Acetylcholinesterase; D002091:Butyrylcholinesterase