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Cholinesterase - blood

Serum cholinesterase is a blood test that looks at levels of two substances that help the nervous system work properly. They are called acetylcholinesterase and pseudocholinesterase. Your nerves need these substances to send signals.

Acetylcholinesterase is found in nerve tissue and red blood cells. Pseudocholinesterase is found primarily in the liver.

Alternative Names

Acetylcholinesterase; RBC (or erythrocyte) cholinesterase; Pseudocholinesterase; Plasma cholinesterase; Butyrylcholinesterase; Serum cholinesterase

How the test is performed

A blood sample is needed. Most of the time blood is drawn from a vein located on the inside of the elbow or the back of the hand.

How to prepare for the test

No special steps are needed to prepare for this test.

How the test will feel

You may feel slight pain or a sting when the needle is inserted. You may also feel some throbbing at the site after the blood is drawn.

Why the test is performed

Your health care provider may order this test if you may have been exposed to chemicals called organophosphates, which are used in pesticides. This test can help determine your risk of poisoning.

Less often, this test may be done:

  • To diagnose liver disease
  • Before you receive anesthesia with succinylcholine, which may be given before certain procedures or treatments, including electroconvulsive therapy (ECT)

Normal Values

Typically, normal pseudocholinesterase values range between 8 and 18 units per milliliter (U/mL).

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What abnormal results mean

Decreased pseudocholinesterase levels may be due to:

  • Acute infection
  • Chronic malnutrition
  • Heart attack
  • Liver damage
  • Metastasis
  • Obstructive jaundice
  • Poisoning from organophosphates (chemicals found in some pesticides)
  • Inflammation that accompanies various diseases 

Smaller decreases may be due to:

  • Pregnancy
  • Use of birth control pills

References

Ford MD. Acute poisoning. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 111.

Aminoff MJ. Effects of toxins and physical agents on the nervous system: effects of occupational toxins on the nervous system. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 62A.

Updated: 5/28/2013

Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network.


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