Abstract
Diagnostic Enzymology covers commonly requested biochemistry tests, with explanations about their functions, methods of measurement and clinical use. The authors’ aim is to provide a resource for those supervising and training within Chemical Pathology and to aid in the interpretation of changes in enzyme values. I was interested that the term ‘diagnostic’ was included within the title and hoped that this indicated a clinical grounding to this relatively compact book.
This is the second edition of the title, initially published 28 years ago, and it has been updated to reflect standardization of methods along with additional coverage of naturetic peptides. It consists of 10 chapters covering the commoner enzymes such as the aminotransferases (ALT and AST), creatinine kinase, lactate dehydrogenase and some of those less frequently seen in the clinical laboratory such as butylcholinesterase and aldolase. Naturetic peptides are also included even if not traditionally recognized as enzymes. The inclusion of some enzymes is slightly puzzling from a British perspective (e.g. the chapter on aldolase) whereas the more commonly measured enzyme amylase is omitted. This may reflect the intended international readership.
Each chapter follows a similar format including three to six short clinical cases involving abnormalities of the enzyme in different scenarios. The cases include not only biochemistry data but also pertinent findings from other pathology disciplines and radiological investigations. Cases are followed by a discussion giving a clear explanatory background and relevance of the biochemical abnormality to the case in question.
The editors have produced a clear structure for each chapter, with subdivision into sections providing information on reference intervals, analytical methods, interferences and practicalities of measurement. The subsections are concise and often supplemented by tables and illustrative diagrams augmented by informative and appropriate text.
Within the chapters, the function and diagnostic value of the enzymes are explained. The depth of coverage is illustrated by some more unusual measurements such as the quantification of gamma-glutamyl transferase in urine. It also provides information where the tests may have become obsolete, such as measurement of CK-MB being surpassed following the advent of the troponins. The authors also touch on some fundamentals of diagnostic testing in general, including the importance of Bayes’ theorem and how pre-test probability is intrinsically linked to the interpretation of test results.
Every chapter concludes with a number of questions about the analyte which follow a ‘true or false’ format. The answers are not included within the book, which may be a disadvantage for those reading this on the move, but they are accessible from the internet on a specified webpage. Unfortunately, the published URL lacks the ‘pdf’ suffix required to locate the webpage.
This would be a good revision aid for those working towards the Part One FRCPath Examination. Although larger texts such as Tietz provide more detailed descriptions of methods, this title provides concise explanations which will aid essay writing. The case studies would also provide a good revision aid for those approaching the FRCPath Oral Examination. Interpreting results within a clinical context and adding value to numerical outputs to help the diagnostic pathway are key in modern medicine and this book supports this approach.
I do think the authors have successfully produced a text which is not only very readable and useful to students and teachers of chemical pathology, but also of relevance in relation to clinical queries arising on a daily basis. This book would be a valuable addition to any biochemistry department library.