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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As part of the Nordic Reference Interval Project we present reference intervals for alanine transaminase (ALT), aspartate transaminase (AST), creatine kinase (CK), lactate dehydrogenase (LD), alkaline phosphatase (ALP), gamma-glutamyltransferase (GT), amylase (AMY) and pancreatic type of AMY in blood of adult males and females. A total of 3036 reference persons, all of whom considered themselves to be in good health, were recruited by 102 Nordic clinical biochemical laboratories. Exclusions were undertaken on the basis of predefined biochemical and clinical criteria. Enzyme activities in serum and plasma were measured in the different laboratories using various commercially available routine measurement systems at 37 degrees C. Only results obtained with the International Federation of Clinical Chemistry (IFCC) compatible measuring systems were selected for estimation of the enzyme reference intervals. The final number of results on each enzyme varied from 459 (LD) to 2300 (ALT). The 2.5 and 97.5 percentile reference limits were calculated by a non-parametric method in accordance with the IFCC recommendations, using the Refval 4.0 data program. Statistical partitioning testing was undertaken to decide whether the reference intervals ought to be partitioned according to gender and/or age. For most of the enzymes, but not for all, the upper reference limits were found to be higher than those that have been in general use until now.
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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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