Immunology Lab Flashcards
Monoclonal Gammopathies are also called
plasma cell dyscrasias
What occurs in monoclonal gammopathies?
There’s an abnormal proliferation of a clone of Ig secreting cells (usually plasma cells) resulting in the production of monoclonal (M) antibody (protein)
- All antibodies they produce are identical b/c they’re from the same clone
Antibodies in multiple myeloma
IgG, IgA, IgE, IgD, or light chains only
Primary amyloidosis is often referred to as
Bence Jones proteins
___ is produced in primary amyloidosis
excess free light chain
Example of lymphoproliferative disorder in primary amyloidosis. what antibody to they make?
waldenstrom’s macroglobulinemia
Only makes IgM
___ is a classic symptom of patients w/ multiple myeloma
Bone pain
Over time, monoclonal or polyclonal antibody will be major antibody in patients plasma as disease progresses
Monoclonal
___% of patients have mandibular involvement for myeloma patients, and 15% of them have ___ showing up in mandible at first
30
primary presentation
Describe serum protein electrophoresis (SPE). what are the steps?
performed to detect the presence of an M protein suggesting a diagnosis of multiple myeloma or waldenstrom’s macroglobulin
Patient serum is placed on gel → protein w/ greatest negative charge migrates to positive end of electrode → gel is put in densitometer which draws out what different patients serum looks like
___ migrates in serum protein electrophoresis
Albumin
If a patient has ___, the gamma globulin region is down to the baseline b/c patient wouldn’t be making antibodies
x-linked ammaglobulinemia
Describe monoclonal response in serum protein electrophoresis
a clone of plasma cells expands & makes same antibody & produce M protein
Describe polycloncal response in serum protein electrophoresis
different clones of cells contribute to the pattern & make antibodies w/ different specificities so migrate differently
- This is seen in normal patients
When is the earliest detectable time for patients w/ multiple myeloma?
Close to patient death, so have to treat aggressively
A polyclonal response is also called ___. Is it cancerous or benign?
plasma cell granuloma
Benign
___ is a form of multiple myeloma
Plasmacytoma
Immunohistochemical staining steps
- Tissue biopsy + add antibody against kappa (reacts w/ kappa light chain) to 1 section & a 2nd section against lambda (reacts w/ lambda light chain) & both antibodies are labeled w/ an enzyme wash to remove excess antibody + add enzyme substrate
- Then look for color deposit in tissue when enzyme activates substrate
If you have a lesion in the mouth you need to do what to determine if it’s malignant or benign?
Need to stain tissue for kappa & lambda light chain expression
If plasma cell stains only for kappa or only for lambda
If plasma cell stains both for kappa & lambda
multiple myeloma
granuloma (polyclonal response)
Amyloid deposits may consists of ___
free monoclonal kappa or lambda light chains has deposited in tissue
How do stain amyloid deposits to see them under a light microscope? What will you see?
stain the tissue w/ congo red & under a light microscope w/ polarized light & you’ll see apple-green birefringence
history of blurred vision & bleeding gums is what type of monoclonal gammopathies
Primary amyloidosis, specifically waldenstrom’s macroglobulinemia
Describe IgM in waldenstrom’s macroglobulinemia. It is associated w/ ___ syndrome
IgM is so large that it remains in blood (Increase of IgM in blood) & won’t go into tissue (doesn’t readily get out of vascular system) & has difficulty crossing mucosa b/c IgA competition
hyperviscosity syndrome
Hyperviscosity syndrome symptoms:
- Oozing of blood from mucosa
- Nose bleeding
- Minor surgical procedures result in prolonged bleeding
- Disturbance of vision (BV are swollen)
Hyperviscosity syndrome treatment
Plasmapheresis (dilute their plasma & IgM decreases)
Immunofluorescence studies involves staining tissue w/ ___ labeled w/ ___, then tissue biopsy is stained & washed & examined for ___ under a ___ microscope
Antibodies
fluorescent dye
specific fluorescence
fluorescent
What are the steps for direct immunofluorescence?
Tissue biopsy from mouth + add antibody labeled w/ fluorescent dye → then look for specific fluorescence under fluorescent microscope
blister like lesion in mouth & lesions on arms & legs is __ disease
pemphigus
Where is the antibody in pemphigus vulgaris? What type of appearance of the fluorescence in the epithelium does it have?
Antibody is against intracellular substances in epidermis
Has an intact mucous membrane
Has chicken wire appearance of the fluorescence in the epithelium
Pemphigus & pemphigoid diseases have type ___ hypersensitivity
type II
Symptoms for pemphigoid disease
lesions on mouth, not skin
has a bothersome lesion of the conjuctiva of the eye & no skin involvement
Where is the antibody located in pemphigoid disease? Where is the fluorescence located & is it linear or curved?
Dermis separated from epidermis at basement membrane
Antibody is against basement membrane
Basement membrane & linear
T/F: Pemphigus disease is benign
False
Pemphigoid disease is benign
Lesion on hands & face are __ disease. It is a type ___ hypersensitivity rxn
systemic lupus erythematosus (SLE)
Type III
Where are the deposits of immune complexes for SLE? Are they linear or bumpy?
Deposits of immune complexes at basement membrane or dermal-epidermal junction
bumpy
An ___ test will be positive in patients w/ SLE
anti-nuclear antibody test
Type II hypersensitivity reactions can be associated w/
blood transfusion reaction & hyperacute graft rejections
Organ or cell specific autoimmune disease
- Hashimoto’s thyroiditis
- Pemphigus vulgaris
- (benign) Mucous membrane pemphigoid (BMMP or MMP)
- Autoimmune hemolytic anemia
- Myasthenia gravis
Hashimoto thyroiditis antibodies
anti-thyroid antibodies
Pemphigus vulgaris antibodies
Antibodies to intracellular substance of the epithelium
(benign) Mucous membrane pemphigoid (BMMP or MMP) antibodies
Antibodies to basement membrane
Autoimmune hemolytic anemia antibodies
antibodies to RBC
Myasthenia gravis antibodies ___. What happens?
Antibody against Ach receptor
- Antibody reacts w/ Ach receptors & cause them to go inside cytoplasm or disappear & patient doesn’t have any receptors to react w/ Ach
- Muscles are weakened
