Common Patterns Flashcards
Monoclonal (M-Spike) Pattern
- Seen in Multiple Myeloma, Waldenström’s Macroglobulinemia
- A sharp, narrow spike in the gamma region (or sometimes beta region)
Indicates a monoclonal immunoglobulin (paraprotein)
Polyclonal Gammopathy
- Seen in Chronic Infections, Liver Disease, Autoimmune Disorders
- Broad, diffuse increase in the gamma region (not a sharp spike)
Suggests a generalized immune response
Hypogammaglobulinemia
- Seen in Immunodeficiencies (e.g., CVID, SCID, Nephrotic Syndrome)
- Decreased gamma region (reduced immunoglobulins)
Nephrotic Syndrome Pattern
↓ Albumin (due to protein loss)
↑ Alpha-2 Globulins (increased α2-macroglobulin due to compensatory synthesis)
Liver Disease Pattern
- Seen in Cirrhosis, Chronic Liver Disease
↓ Albumin (liver dysfunction)
Polyclonal increase in Gamma (due to chronic inflammation)
β-γ Bridging (fusion of beta and gamma regions due to IgA elevation)
Acute Inflammatory Pattern
- Seen in Infections, Trauma, or Acute Inflammation
- ↑ Alpha-1 and Alpha-2 Globulins (acute-phase reactants like alpha-1 antitrypsin and haptoglobin)
Normal or slightly reduced albumin - later may have an increase in b2 fraction
Chronic Inflammatory Pattern
- Seen in Autoimmune Diseases (e.g., Rheumatoid Arthritis, SLE)
- Polyclonal Gamma Elevation
Mild decrease in albumin
Alpha-1 Antitrypsin Deficiency
↓ Alpha-1 Globulin Band (due to deficiency of alpha-1 antitrypsin)
Caplillary vs. Gel
- Gel results tend to have:
- Broader, lower gamma profile
- smaller alpha 1 fraction
- lower resolution
Beta region protein pattern abnormalities requiring Immunofixation/Immunotyping
- isolated increase in beta-2 (beta2 > beta1) in the absence of hepatic or inflammatory disorder
- distorted/irregular beta-2 fraction (especially if associated with hypogammaglobulinemia)
- increased beta-1 zone in the absence of iron deficiency
- distored/irregular beta 1 fraction, especially if associated with hypogammaglobulinemia
Fibrinogen
- in beta 2
- could look like bridging
- symmetrical gamma region
- maybe run on plasma instead of serum
- band does not appear with pentavalent antisera
- may be because of clotting problems (fibrinogen is not used up)
Alpha region patterns requiring Immunofixation/Immunotyping
- isolated increase of alpha-2 fraction should be treated as suspicious when:
- sample is not hemolyzed
- inflammatory or nephrotic disorder os not present/confirmed
- hypogammaglobulinemia is present
- rare
- never in alpha 1
Beta-gamma bridging
- Beta-gamma bridging
- increase of B2 with or without associated hypergammaglobulinemia and with a known hepatic problem or viral infection
- beta-gamma bridging is caused by polyclonal increase of IgA
- if unsure, needs IT/IFE
Shoulder on left side of Albumin fraction
- turbid or icteric samples
- serum highly lipemic
Shoulder on right side of Albumin fraction
- elevated lipoproteins or biliary pigments
- check the color of the serum (bright orange)
Alpha-1 Antitrypsin Phenotypes
- manifested by double peaks in alpha 1 fraction
- two different phenotypes (forms)
- depending on the phenotype, one of the peaks occasionally can migrate in alpha-2
- could also indicate alpha-1 antitrypsin deficiency
Haptoglobin phenotypes
- patients create two forms of haptoglobin
- two peaks in alpha2 without an increase in a2 fraction concentration value or hypogammaglobulinemia
- no IFE/IT needed
Hemolysis
- increase in beta1 and associated distorion of alpha2
- free hemoglobin migrates in the beta1 zone, but haptoglobin-Hb complex migrates in alpha2 zone
- note serum appearance
- hemolytic anemia or poor storage
Contrast Dyes and Antibiotics on CE
Anodal to Prealbumin - Ceftriaxone sodium
Prealbumin - Bilisegrol
Albumin (anodal edge) - Sulfamethoxazone
Alph2 (anodal) - Gastrografin, Urograffin & Uroangiografin
Alph2 (middle) - Telebrix & Xenetrix
Alpha2 (cathodal) - Omnipaque, Omnitrast, Ultravist
Beta1 (anodal) - Piperacillin-taxobactam
Beta2 (anodal) - Optiray
Beta2 (middle) - Iomeron
Reflex these to antisera, which will not cause the peak to go away
