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25 Cards in this Set

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Name five things serum proteins are useful for.
1. Osmotic pressure
2. Immune reactions
3. Lipid metabolism
4. Transport
5. Coagulation
What two things are usually tested for using electrophoresis?
1. Monoclonal proteins
2. Analysis of hemoglobin variants
What two things are usually tested for using colorimetric testing?
1. Total protein
2. Albumin
What are three examples of immunoassays?
1. Turbidity - scattering light
2. Nephelometry - light at 90
3. Sandwhich assay
What is albumin's primary function in the blood? What is its usual concentration and what is its half-life?
1. Maintain intravascular osmotic pressure
2. 3-5% g/dL
3. 19 days
What are other purposes of albumin besides maintaining osmotic pressure?
1. Transport
2. Buffer
What is a marker for a good sample of CSF?
Prealbumin
What is the order from most positive to most negative in terms of serum plasma proteins on a gel?
1. Gamma (antibodies)
2. Beta
3. Alpha-2
4. Alpha-1
5. Albumin
In nephrotic syndrome patients, which two spikes would be very large in comparison to the rest of them and why?
1. Alpha-2 Macroglobin
2. Beta-1 Lipoprotein
3. They are too large to be filtered even in a damaged kidney
What four conditions might you see reduced serum proteins across the board (except for gamma)?
1. Trauma/Burns
2. Malnutrition
3. Malabsorption
4. Hemorrhage
In liver cirrhosis, what pattern is seen?
In cirrhosis of liver, in terms of electrophoretic pattern, there is a huge gamma region increase and decrease in other regions.
What is the primary reason for doing electrophoresis in a routine lab?
To test for monoclonal gammopathies (multiple myloma).
Why do you usually not see a light chain on SPE?
They are cleared by the kidneys and are largely reabsorbed. As the clone produces more and more light chains, the nephrons become overwhelmed and their reabsorption ability decreases. If you get an SPE back and you still have a strong clinical suspicion, you should order a 24 hour urine electrophoresis to make sure it’s not a light chain gammopathy.
What is a paraprotein?
Result of a single clone of plasma cells which produce Ig molecules with identical structures.
Why is it important to type a monoclonal gammopathy?
A. To confirm the presence of a paraprotein.
B. To aid in diagnosis. (IgM is likely to be a Waldenstrom’s macroglobulinemia)
C. To aid in prognosis.
Paraprotein of IgM is most likely what syndrome?
Waldenstrom’s macroglobulinemia
Franklin's disease involves which chain?
The light chain
What bands do you look at and where do you look for them in a diagnosis of MS?
1. IgG kappa and lambda bands
2. CSF
What is a classic sign of multiple myloma?
X-ray revealed punched out lesions of the clavicles, ribs, and skull.
What are classic SLE showings for MM?
High gamma region with low albumin.
What is the diagnostic problem and solution in light chain multiple myloma?
Problem: There is hypogammaglobulinemia with no monoclonal spike on SPE and conventional urinary dipsticks do not detect Bence Jones proteinuria.

Solution: Take a 24 hour urine collection with immunofixation on all patients with hypogammaglobulinemia.
What is the diagnostic problem in non-secretory myeloma?
There is no monoclonal protein in the serum or urine.

All you can do is hope to pick it up on the immunoperoxidase stain of plasma cells.
What is the diagnostic problem in IgD and IgE multiple myloma?
Reaction with light chain sera only.

Use IgE and IgD antisera
What is the diagnostic problem in monoclonal protein in the serum or urine?
Problem: Differentiation of MGUS (monoclonal gammopathy of uncertain significance) from a plasma-proliferative disease.

Solution: Knowledge of the diagnostic criteria for multiple myeloma and MGUS. Appropriate patient follow-up over time.
In what other areas of the electrophoretic pattern can monoclonal spikes be found? What test would you order?
Right up to the alpha-2 region and then all the way off the end of the gel. Anywhere in this region.

Immunofixation electrophoresis.