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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
Q

Location of application point on a gel lane

A

In Beta 2

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26
Q

What causes transitory bisalbuminemia?

A

Drug albumin complexes, acquired

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27
Q

Difference between in vivo and in vitro hemolysis

A

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

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28
Q

A bit of every protein fraction (except gamma) going up suggests..?

A

Acute inflammation

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29
Q

What to suspect when a monoclonal is found in the serum electrophoresis, but not in the immunofixation?

A

Fibrinogen present (plasma sample used)

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30
Q

Proteinuria due to nephrotic syndrome; no monoclonal seen

A

Glomerular damage

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31
Q

3 potential consequences of an in vitro hemolyzed sample on interpretation

A
  • Increased beta (free hgb is here)
  • Band between a2 and B (haptoglobin-hgb complex)
  • Looks like a paraprotein
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32
Q

Why is the Biuret method not suitable for protein quantitation in CSF and urine?

A

Not sensitive enough

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33
Q

What is MGUS?

A

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

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34
Q

Possible disease when there’s increased IgM?

A

Waldenstrom’s macroglobulinemia

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35
Q

2 ways to confirm it’s not fibrinogen

A
  • Fibrinogen assay

- Immunofixation if you think it’s a protein -> fibrinogen will have no rxn

36
Q

2 types of proteins in CSF that may be a result of intrathecal synthesis

A
  • Ig

- Transthyretin (pre-albumin)

37
Q

Associated diseases seen with polyclonal gammopathy?

A

Hepatic infections
AIDS
Autoimmune diseases

38
Q

This type of hypergammaglobulinemia is NOT malignant

A

Polyclonal increases in immunoglobulins

39
Q

Extremely rare, difficult to diagnosis and is underdiagnosed

A

Amyloidosis

40
Q

2 ways to treat a hyperviscous serum sample (Waldenstrom’s)?

A

Treat with either:

  • 2BME
  • Fluidil
41
Q

Peak shape of transitory bisalbuminemia - which one is the drug one?

A

One peak is smaller - drug-albumin complex is larger complex (moves slower)

42
Q

2 diseases associated with ceruloplasmin

A

Wilson’s disease

Menkes’ disease (kinky hair disease)

43
Q

Main difference between multiple myeloma and Waldenstrom’s macroglobulinemia in terms of symptoms

A

Waldenstrom’s - NO BONE PAIN

44
Q

Cause of slurring/smearing of albumin peak?

A

Binding of bilirubin to albumin in liver disease

45
Q

Decrease in this protein may suggest Down’s syndrome

A

a1-fetoprotein

46
Q

Conjugated protein = ___________ + __________

A

apoprotein + prosthetic group

47
Q

Beta-gamma bridge suggests these 2 diseases

A

Viral hepatitis

Chronic liver disease (cirrhosis)

48
Q

Proteins are _________ molecules b/c they contain both an acidic and basic groups

A

amphoteric

49
Q

4 main signs of multiple myeloma

A
  • Unexplained anemia
  • Unexplained renal insufficiency
  • Hypercalcemia
  • Bone lesions, bone pain

CRAB
(calcium, renal, anemia, bone)

50
Q

4 possible reasons for hypogammaglobulinemia

A
  • Immunosuppressive treatment
  • Newborn
  • Immunodeficiency
  • Secondary protein loss (nephrotic syndrome)
51
Q

Most common SPE gel stain

A

Amido black B

52
Q

This assay is helpful in assessing the disease status of amyloidosis

A

Freelite Serum free light chain assay (to track light chain levels)

53
Q

2 causes of increased ESR

A
  • Inflammation (acute phase rxn)

- Increased fibrinogen, other globulins in plasma causing rouleaux

54
Q

3 signs suggestive of nephrotic syndrome based on SPE banding

A

Decreased total protein

Retention of high MW proteins (a2-macroglobulin, lipoproteins)

Low gamma globulins

55
Q

How do acute and chronic inflammation differ in terms of protein fractions?

A

Chronic =

  • higher IgG
  • lower albumin
  • INCREASED GAMMA (main difference)
56
Q

What are cryoglobulins

A

Proteins that REVERSIBLY PRECIPITATE in serum if left overnight/over 72 hrs in fridge

57
Q

Spike in transferrin (b1) may suggest..?

A

Iron deficiency anemia

58
Q

Reference method for determining total protein?

A

Kjeidahl - “Nitrogen content method”

59
Q

How to remove fibrinogen from plasma?

A

Add thrombin, allow to clot, spin

60
Q

Possible cause of nephrotic syndrome?

A

Diabetes mellitus

61
Q

Which immunoglobulins are more likely to be associated with multiple myeloma?

A

IgG or IgA

62
Q

Polyclonal gammopathy is mainly observed in patients w/ one of these 3 diseases

A
  • Hepatic infections
  • AIDS
  • Autoimmune disease
63
Q

Best total protein determination method for fluids with few types of proteins (e.g. CSF, urine)

A

Dye binding

64
Q

Which peak would ceruloplasmin be found in?

A

a2

65
Q

Most important and essential test for multiple sclerosis?

A

Detection of humoral immune response within the CNS

66
Q

Absense of a1-antitrypsin would result in what?

A

Elastase is free to breakdown elastin = dyspnea, emphysema, COPD

67
Q

An increased in a1 is usualy accompanied by..?

A

An increase in a2

68
Q

3 inter beta/gamma proteins

A
  • fibrinogen (if plasma)
  • CRP
  • IgA
69
Q

How many times must CSF be concentrated before performing high res electrophoresis?

A

50 fold

70
Q

No observed pathological effect in this disorder

A

Bisalbuminemia

71
Q

Major component of Beta 1 fraction

A

Transferrin

72
Q

Why is a polyclonal increase in immunoglobulins not a malignant disease?

A

B/c it’s a diffuse mix of antibodies - not a paraprotein

73
Q

This protein is a sensitive nutritional marker - decreases before other proteins

A

Pre-albumin (transthyretin)

74
Q

First acute phase reactant + its protein fraction

A

C-reactive protein; beta 2 but located between beta 2 and gamma

75
Q

Holds 95% of the body’s copper; cofactor for many enzymes

A

Ceruoplasmin

76
Q

Oligoclonal gammopathy can be observed in what 4 diseases?

A
  • MM or malignant proliferation
  • Autoimmune diseases (rheumatoid arthritis, lupus)
  • Infectious diseases (viral, bacterial, parasitic)
  • Autoimmune due to transplants, immunosuppressive treatment
77
Q

A bit of every protein fraction (incl. gamma) going up suggests..?

A

Chronic inflammation

78
Q

Monoclonal gammopathy treatment option that helps

  • slow the advancement of bone disease,
  • decrease bone pain
  • reduce fractures
A

Bisphosphonates

79
Q

What is amyloidosis

A

Abnormal deposition of monoclonal free light chains in multiple organs or tissue

80
Q

This protein may be up to 10x increased to compensate the loss of low MW proteins in urine

A

a2-macroglobulin

81
Q

Oligoclonal increase can be due to immune response to 3 things:

A
  • Viral infections
  • Autoimmune disease
  • CSF of multiple sclerosis
82
Q

Increase in this protein fraction may suggest hemolysis or acute phase reactants

A

Alpha 2

83
Q

Why is polyclonal gammopathy not malignant?

A

All clones go up, no spikes present

84
Q

2 proteins in beta 2 fraction

A

Complement (C3)

CRP

85
Q

What to suspect when a monoclonal band is found in ALL immunofixation tracks?

A
  • Cryoglobulin

- Polymerized IgM

86
Q

Neoplastic plasma cells proliferate in the bone marrow = what disease?

A

Multiple myeloma

87
Q

Lack of a1 peak may suggest..?

A

Lack of a1 antitrypsin

Clinical Chemistry 2 (15 decks)

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