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Clinical Chemistry 2 > 9-11. Serum Protein Electrophoresis, Immunofixation (SPE and IFE) > Flashcards

9-11. Serum Protein Electrophoresis, Immunofixation (SPE and IFE) Flashcards

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1
Q

Decreased levels of this protein may be due to old sample

A

C3 (heat-labile + denatures on storage @RT)

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2
Q

Ceruloplasmin and copper relative levels in Wilson’s disease?

A

LOW cer

HIGH HIGH Cu

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3
Q

Function of haptoglobin and which protein fraction is it found in?

A

Alpha 2

Binds free hgb; acts as a scavenger to recycle hgb parts

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4
Q

Ceruloplasmin and copper relative levels in Menkes’ disease?

A

LOW cer

LOW Cu

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5
Q

Most common type of myeloma?

A

IgG myeloma with kappa or lambda light chains

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6
Q

Proteinuria due to paraproteins and free light chains in monoclonal gammopathies

A

Overload proteinuria

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7
Q

Increasing this property of the buffer will provide sharper band separation

A

Ionic strength

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8
Q

2 proteins in beta 1 fraction

A

Transferrin

Lipoproteins

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9
Q

Most plasma proteins are ________ charged at normal blood pH

A

negatively

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10
Q

Slurring of albumin may be seen with this disease

A

Liver disease (due to binding of bilirubin to albumin)

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11
Q

Potential sources of false positives in biuret method of total protein determination?

A

Hemolysis
Lipemia
Bilirubin

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12
Q

Increase of __ globulins may be due to iron deficiency anemia

A

Beta

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13
Q

What causes the formation of a beta-gamma bridge?

A

Marked IgA increase

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14
Q

2 reasons for bisalbuminemia?

A
  • Congenital

- Drug binding

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15
Q

Secondary hypogammaglobulinemia can occur in response to treatment with what 4 things?

A
  • Corticosteroids
  • Immunosuppressants
  • Chemotherapy
  • Radiotherapy
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16
Q

Disorder that causes very low albumin but substantial increase of 4 globulin fractions to compensate for severe hypoalbuminemia to maintain oncotic pressure?

A

Congenital analbuminemia

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17
Q

Most resolutive and sensitive technique for detection of IgG oligoclonal bands?

A

CSF isoelectric focusing (IEF)

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18
Q

Protein that inhibits proteases (trypsin, pepsin, plasmin)

A

a2-macroglobulin

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19
Q

Serum and CSF carrier of the thyroxine (T4); AKA pre-albumin

A

Transthyretin (TTR)

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20
Q

Lab tests that may suggest multiple myeloma

A
  • High calcium
  • Abnormal kidney and liver tests
  • Low albumin
  • Urinalysis high proteins
  • Increased ESR
  • Hematology PBF - plasma cells

CRAB = high Calcium, Renal failure, Anemia, Bone lesions

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21
Q

What is the only DEFINITIVE sign of amyloidosis?

A

Macroglossia (stiffling of tongue)

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22
Q

Another test that can help diagnose acute inflammation?

A

ESR

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23
Q

Main indicator on SPE pattern that suggests chronic liver disease?

A

Beta-gamma bridge

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24
Q

Proteinuria due to Waldenstrom’s or myeloma

A

Tubular damage

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25
Location of application point on a gel lane
In Beta 2
26
What causes transitory bisalbuminemia?
Drug albumin complexes, acquired
27
Difference between in vivo and in vitro hemolysis
In vivo - hgb-haptoglobin complex quickly removed from bloodstream, causing low serum haptoglobin levels => depressed a2 band In vitro - released hgb binds haptoglobin to form complex => appears as split a2 bands or smeared a2 *Free hgb increases beta-1 band
28
A bit of every protein fraction (except gamma) going up suggests..?
Acute inflammation
29
What to suspect when a monoclonal is found in the serum electrophoresis, but not in the immunofixation?
Fibrinogen present (plasma sample used)
30
Proteinuria due to nephrotic syndrome; no monoclonal seen
Glomerular damage
31
3 potential consequences of an in vitro hemolyzed sample on interpretation
- Increased beta (free hgb is here) - Band between a2 and B (haptoglobin-hgb complex) - Looks like a paraprotein
32
Why is the Biuret method not suitable for protein quantitation in CSF and urine?
Not sensitive enough
33
What is MGUS?
Monoclonal Gammopathy of Uncertain Significance Asymptomatic monoclonal gammopathy - patients have monoclonal in serum/urine but without a specific diagnosis 68% of patients with monoclonal gammopathies are classified as MGUS
34
Possible disease when there's increased IgM?
Waldenstrom's macroglobulinemia
35
2 ways to confirm it's not fibrinogen
- Fibrinogen assay | - Immunofixation if you think it's a protein -> fibrinogen will have no rxn
36
2 types of proteins in CSF that may be a result of intrathecal synthesis
- Ig | - Transthyretin (pre-albumin)
37
Associated diseases seen with polyclonal gammopathy?
Hepatic infections AIDS Autoimmune diseases
38
This type of hypergammaglobulinemia is NOT malignant
Polyclonal increases in immunoglobulins
39
Extremely rare, difficult to diagnosis and is underdiagnosed
Amyloidosis
40
2 ways to treat a hyperviscous serum sample (Waldenstrom's)?
Treat with either: - 2BME - Fluidil
41
Peak shape of transitory bisalbuminemia - which one is the drug one?
One peak is smaller - drug-albumin complex is larger complex (moves slower)
42
2 diseases associated with ceruloplasmin
Wilson's disease Menkes' disease (kinky hair disease)
43
Main difference between multiple myeloma and Waldenstrom's macroglobulinemia in terms of symptoms
Waldenstrom's - NO BONE PAIN
44
Cause of slurring/smearing of albumin peak?
Binding of bilirubin to albumin in liver disease
45
Decrease in this protein may suggest Down's syndrome
a1-fetoprotein
46
Conjugated protein = ___________ + __________
apoprotein + prosthetic group
47
Beta-gamma bridge suggests these 2 diseases
Viral hepatitis | Chronic liver disease (cirrhosis)
48
Proteins are _________ molecules b/c they contain both an acidic and basic groups
amphoteric
49
4 main signs of multiple myeloma
- Unexplained anemia - Unexplained renal insufficiency - Hypercalcemia - Bone lesions, bone pain CRAB (calcium, renal, anemia, bone)
50
4 possible reasons for hypogammaglobulinemia
- Immunosuppressive treatment - Newborn - Immunodeficiency - Secondary protein loss (nephrotic syndrome)
51
Most common SPE gel stain
Amido black B
52
This assay is helpful in assessing the disease status of amyloidosis
Freelite Serum free light chain assay (to track light chain levels)
53
2 causes of increased ESR
- Inflammation (acute phase rxn) | - Increased fibrinogen, other globulins in plasma causing rouleaux
54
3 signs suggestive of nephrotic syndrome based on SPE banding
Decreased total protein Retention of high MW proteins (a2-macroglobulin, lipoproteins) Low gamma globulins
55
How do acute and chronic inflammation differ in terms of protein fractions?
Chronic = - higher IgG - lower albumin - INCREASED GAMMA (main difference)
56
What are cryoglobulins
Proteins that REVERSIBLY PRECIPITATE in serum if left overnight/over 72 hrs in fridge
57
Spike in transferrin (b1) may suggest..?
Iron deficiency anemia
58
Reference method for determining total protein?
Kjeidahl - "Nitrogen content method"
59
How to remove fibrinogen from plasma?
Add thrombin, allow to clot, spin
60
Possible cause of nephrotic syndrome?
Diabetes mellitus
61
Which immunoglobulins are more likely to be associated with multiple myeloma?
IgG or IgA
62
Polyclonal gammopathy is mainly observed in patients w/ one of these 3 diseases
- Hepatic infections - AIDS - Autoimmune disease
63
Best total protein determination method for fluids with few types of proteins (e.g. CSF, urine)
Dye binding
64
Which peak would ceruloplasmin be found in?
a2
65
Most important and essential test for multiple sclerosis?
Detection of humoral immune response within the CNS
66
Absense of a1-antitrypsin would result in what?
Elastase is free to breakdown elastin = dyspnea, emphysema, COPD
67
An increased in a1 is usualy accompanied by..?
An increase in a2
68
3 inter beta/gamma proteins
- fibrinogen (if plasma) - CRP - IgA
69
How many times must CSF be concentrated before performing high res electrophoresis?
50 fold
70
No observed pathological effect in this disorder
Bisalbuminemia
71
Major component of Beta 1 fraction
Transferrin
72
Why is a polyclonal increase in immunoglobulins not a malignant disease?
B/c it's a diffuse mix of antibodies - not a paraprotein
73
This protein is a sensitive nutritional marker - decreases before other proteins
Pre-albumin (transthyretin)
74
First acute phase reactant + its protein fraction
C-reactive protein; beta 2 but located between beta 2 and gamma
75
Holds 95% of the body's copper; cofactor for many enzymes
Ceruoplasmin
76
Oligoclonal gammopathy can be observed in what 4 diseases?
- MM or malignant proliferation - Autoimmune diseases (rheumatoid arthritis, lupus) - Infectious diseases (viral, bacterial, parasitic) - Autoimmune due to transplants, immunosuppressive treatment
77
A bit of every protein fraction (incl. gamma) going up suggests..?
Chronic inflammation
78
Monoclonal gammopathy treatment option that helps - slow the advancement of bone disease, - decrease bone pain - reduce fractures
Bisphosphonates
79
What is amyloidosis
Abnormal deposition of monoclonal free light chains in multiple organs or tissue
80
This protein may be up to 10x increased to compensate the loss of low MW proteins in urine
a2-macroglobulin
81
Oligoclonal increase can be due to immune response to 3 things:
- Viral infections - Autoimmune disease - CSF of multiple sclerosis
82
Increase in this protein fraction may suggest hemolysis or acute phase reactants
Alpha 2
83
Why is polyclonal gammopathy not malignant?
All clones go up, no spikes present
84
2 proteins in beta 2 fraction
Complement (C3) | CRP
85
What to suspect when a monoclonal band is found in ALL immunofixation tracks?
- Cryoglobulin | - Polymerized IgM
86
Neoplastic plasma cells proliferate in the bone marrow = what disease?
Multiple myeloma
87
Lack of a1 peak may suggest..?
Lack of a1 antitrypsin

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