A comparison between naturally occurring macroamylasaemia and macroamylasaemia induced by hydroxyethyl‐starch

Abstract

Macroamylasaemia was produced in vitro by incubation of hydroxyethylstarch with serum, and in vivo by intravenous infusion of hydroxyethylstarch. Gel filtration on Sephadex G-100 revealed distinct differences in molecular size distribution between such hydroxyethylstarch-induced macroamylase and the usual form of naturally occurring macroamylase which was observed in a few patients from our hospital. Further studies demonstrated that the gel filtration elution pattern of amylase activity in serum containing hydroxyethylstarch-induced macroamylase is significantly altered with time in vitro and in vivo, probably because of an enzymatic degradation of the hydroxyethylstarch components of the macromolecular complexes. In a healthy volunteer the serum amylase activity was elevated to a maximum of 797 u/l and the renal clearance rate of amylase was diminished to a minimum of 0.3 ml/min after infusion of 500 ml of a 6% solution of hydroxyethylstarch, as compared to 300 u/l, and 0.95 ml/min, respectively, during the pre-infusion period.

A case of hyperamylasemia: Macroamylasemia? Review of the literature

“…Bu form geçidir. 11,12 Makroamilazeminin temel klinik önemi, yalancı pankreatit tanısına neden olabilmesidir. Normal kantitatif amilaz ölçüm yöntemleriyle immünoglobulinle bağlı makroamilazın normal amilazla ayırımı mümkün değildir.…”

Laboratory and clinical features of abnormal macroenzymes found in human sera

“…In contrast, there have been some reports describing a macroamylase complex with a specific substance, hydroxyethyl starch [83][84][85][86]. Various species of hydroxyethyl starch have been developed for use in the management of hypovolemia, and intravenous infusion results iatrogenic macroamylasemia.…”

Erhöhte Pankreasenzyme ohne erkennbare Pankreaserkrankung

“…Diese Moleküle passieren nicht die Niere, daher ist bei hoher Amylase im Serum und normaler Amylase im Urin die Diagnose einer Makroamylasämie sehr wahrscheinlich. Eine Makroamylasämie soll bei 0,1% der Bevölkerung auftreten [9], kann aber auch künstlich bei Infusion von Hydroxyäthyl-Stärkelösung entstehen [4]. Im positiven Fall sollte der Patient über das Vorhandensein einer Makroamylasä-mie bei ihm unterrichtet werden und eine entsprechende Bescheinigung erhalten, damit spätere Untersucher bei erhöhten Amylasewerten und abdominellen Symptomen die Enzymerhö-hung nicht unbedingt auf eine Pankreaserkrankung beziehen.…”