(M) Sebia Serum Protein Electrophoresis

Question 1

SEBIA is a what test?

Answer 1

Serum Protein Electrophoresis Test (capillary electrophoreiss technology)

Question 2

Six main proteins

Answer 2

1. Albumin
2. Alpha 1
3. Alpha 2
4. Beta 1
5. Beta 2
6. Gamma

Question 3

We are looking for monoclonal peak on what proteins?

Answer 3

gamma, Beta-2, Alpha-2, Beta-1 area

Question 4

Supplier:

A. SEBIA Global Solution
B. SERBIA Global Solution
C. SEBIA International Corporation
D. All of the above

Answer 4

B

Question 5

Fill in the blanks
1. For _________ diagnosis and management.
2. They are _________ for diagnostic tests, follow-up, and even response to the treatment.
3. We also have _________ tests like the Free Light Chain tests, which is done in Sebia FLC or Sterilite
4. they are using a precision medicine which is the _____

Answer 5

1. Multiple myeloma
2. Engaging
3. Complementary
4. Monoclonal Antibody four

Question 6

1. Sebia partnered with?
2. hydrashift monoclonal antibody VRD: identify assay
3. Sanofi Sarclisa: identify assay

Answer 6

1. Janssen Johnson and Johnson Pharmaceutical
2. Daratumumab
3. Isatuximab

Question 7

MINICAP PROTEIN (E) 6:

machine for the Serum Protein Electrophoresis

Answer 7

MINICAP FLEX PIERCING

Question 8

Other than the minicap protein (E) 6 Kit (Ref 2203), there also exists?

Answer 8

minicap protein (E) 6 MAXI Kit (Ref 2223),

Question 9

MINICAP PROTEIN (E) 6:

• Buffer used:

Answer 9

Minicap Protein (E) 6 (ready to use)

Question 10

MINICAP PROTEIN (E) 6:

Reagent Compartment (in order)

4

Answer 10

(left) Buffer Protein 4, Buffer 2, Washing solution, Water (right)

Question 11

MINICAP PROTEIN (E) 6:

TOF. Buffer Protein 4 is not being used because this is allocated for hemoglobin and Hb1c.

Answer 11

F (Buffer 2)

Question 12

• The reagent cup can run how many samples simultaneously?

Answer 12

• 2

Question 13

Tube Characteristic for Minicap Flex Piercing

• PN
• TOF. The supply request (protein E 6, immunotyping and CDT techniques) has to run capped tubes.
• How many sample can a machine run per hour?
• If you shut down the machine, it is around how many minutes?

Answer 13

• 1232
• F (Uncapped tube)
• 20
• 25 minutes

Question 14

Quality Control

• 2 controls
• Pool of lyophilised sera stored between?
• The control is lyophilised and needs to be reconstituted with?
• Wait how many minutes at room temperature before mixing?

Answer 14

• Normal and hyergamma
• 2-8 degrees celsius
• 1 mL of distilled water
• 30 minutes

Question 15

Storage

1. Reconstituted control: _________ degrees celsius for 6 months.
2. Reconstituted control: _________ degrees
   celsius for a week maximum.
3. Thawing/Freezing cycles: _________ times
   maximum.

Answer 15

• -18/-30
• 2/8
• 20

Question 16

Reference value

Normal Control Serum
* 5 x vials
* 20 x vials
Hypergamma Control Serum
* 5 x vials
* 20 x vials

Answer 16

Normal Control Serum:
➔ Ref. 4785: 5 x vials
➔ Ref. 4786: 20 x vials
Hypergamma Control Serum:
➔ Ref: 4787: 5x vials
➔ Ref: 4766: 20 x vials

Question 17

SAMPLES

• (Fresh/Old) samples
• Storage for 10 days
• Storage up to 2 months
• Samples to avoid
• TOF. It is advisable to observe serum aspect before any analysis.

Answer 17

• Fresh
• 2-8 degrees celsius
• -18 to -30 degree celsius
• Hemolyzed, aged of incorrectly stored, plasma
• T

Question 18

TUBES CHARACTERISTICS:

• 5 mL of hemolysing tube: uL?
• If the volume is < 1, use a _ mL microtube on a primary tube (>150uL)
• Tube with gel should have a minimal volume of how many cm?

Answer 18

• 2
• 1.5
• 1

Question 19

INTERPRETATIONS

A. Qualitative abnormalities
B. Quantitative abnormalities

1. increase or decrease fractions
2. presence of peaks or distortions

Answer 19

BA

Question 20

QUESTIONS ANSWERED BY SERUM PROTEIN ELECTROPHORESIS

• Confirm a pathological diagnosis in association with other parameters: (4)
• Identify the presence of a _____ when
  a myeloma is suspected with clinical signs.
• Allow an early detection of _____.
• Monitor the evolution of a _____ disease.
• Follow up the efficiency of an _____.

Answer 20

• inflammation, hepatitis, cirrhosis, or nephrotic profile.
• monoclonal immunoglobulin
• asymptomatic myeloma
• malignant
• immunosuppressive treatment

Question 21

STUDY THE MULTIPLE PATHOLOGIES SCREENING

patterns on the tables correspond to the specific
pathological conditions listed

Answer 21

naka-picture siya

Question 22

PATHOLOGICAL CONDITIONS ON SERUM PROTEIN ELECTROPHORESIS

• Increase alpha-1 and alpha-2 globulins due to an increase of: orosomucoid, alpha-1 antitrypsin and haptoglobin
• Decrease of albumin

Answer 22

Acute inflammation

orosomucoid, alpha-1 antitrypsin and haptoglobin (acute phase reactants)

Question 23

PATHOLOGICAL CONDITIONS ON SERUM PROTEIN ELECTROPHORESIS

Question 24

PATHOLOGICAL CONDITIONS ON SERUM PROTEIN ELECTROPHORESIS

➔ Increase of alpha-1 and alpha-2 globulins
➔ Polyclonal increase of beta and gamma globulins
➔ Decrease of albumin

Answer 24

Chronic Inflammation

Question 25

# PATHOLOGICAL CONDITIONS ON SERUM PROTEIN ELECTROPHORESIS ➔ Decrease off albumin and gamma globulins ➔ Increase of alpha-2 globulins (due to an increase of alpha-2 macroglobulin) ➔ Decrease of total protein concentration ( < 60g/L or 6g/dL).

Answer 25

NEPHROTIC SYNDROME

Question 26

# PATHOLOGICAL CONDITIONS ON SERUM PROTEIN ELECTROPHORESIS ➔ Decrease of albumin, alpha-1 and alpha 2 globulins (due to hepatocellular insufficiency). ➔ Polyclonal increase of beta-gamma globulins (beta-gamma bridge due to polyclonal increase of IgA in beta).

Answer 26

CIRRHOTIC PROFILE

Question 27

# PATHOLOGICAL CONDITIONS ON SERUM PROTEIN ELECTROPHORESIS ➔ Decrease of gamma fraction ➔ Associated with: 1. Partial or total immunodeficiency 2. Immunosuppressive treatment 3. Free light chains disease or non-secreting myeloma ➔ In cases of this, the alpha-2 and beta fractions must be checked carefully for a potential monoclonal abnormality in these fractions.

Answer 27

HYPOGAMMAGLOBULINEMIA

Question 28

# PATHOLOGICAL CONDITIONS ON SERUM PROTEIN ELECTROPHORESIS ➔ Increase of gamma zone due to immune response ➔ Associated with: 1. Cirrhosis 2. Chronic infections

Answer 28

HYPERGAMMAGLOBULINEMIA

Question 29

# PATHOLOGICAL CONDITIONS ON SERUM PROTEIN ELECTROPHORESIS paaral pa rin ng mga pictures

Answer 29

baka ayon lumabas sa midterms exam

Question 30

Myeloma A. Polyclonal immunoglobulin B. Monoclonal immunoglobulin

Answer 30

B (One malignant cell is over-proliferating and the result is the excess of a single immunoglobulin in the serum) ## Footnote in normal conditions, all B lymphocytes produced their immunoglobulins at the same level (poly)

Question 31

TOF. For polyclonal, we have to observe the pointed peak or the pointed curve with a narrow basement. For the multiple myeloma, it has a rounded curve top.

Answer 31

F (multiple myeloma, polyclonal)

Question 32

POSITION OF A MONOCLONAL IMMUNOGLOBULIN IN SERUM PROTEIN ELECTROPHORESIS, except: A. Presence of an additional peak or an additional distortion in beta-1 or beta-2 B. Beta-2 > beta-1 without an inflammatory context or hepatic disease C. Isolated increase or not of beta-1 (without hemolyzed serum or iron deficiency anemia) D. Isolated increase or not of beta-2 (without inflammatory context) E. NOTA

Answer 32

NOTA

Question 33

# Capillary electrophoresis * This is required every time you see a monoclonal immunoglobulin. * This test will determine what kind of myeloma or cancer the patient has.

Answer 33

* Complementary immunofixation/immunotyping * Immunotyping

Question 34

# ADDITIONAL FRACTION IN ALPHA-2 * ____ sample (haptoglobin-hemoglobin complex). * It can be associated with a ____ increase due to free hemoglobin. * Specific phenotypes of ____ (genetic mutation) * Presence of ____ ____.

Answer 34

* Hemolyzed * beta 1 * haptoglobin * monoclonal immunoglobulin

Question 35

1. High peak on the gamma area 2. Weak monoclonal immunoglobulin A. Typical myeloma B. Monoclonal immunoglobulin C. Strong monoclonal immunoglobulin

Answer 35

1. C 2. AB

Question 36

Monoclonal component quantification is required for, except: A. Treatment deficiency follow up B. Monitoring evolution from non-malignant state of a gammopathy to a malignant state C. MGUs Vs. Smoldering myeloma D. NOTA

Answer 36

D

Question 37

# Pattern ● Presence of 3 or more faint, narrow and homogeneous bands. ● Hypergammaglobulinemia, that gives a picture of multiple monoclonal bands ● This profile is observed in: 1. Autoimmune reactions associated with transplants 2. Patients under immuno-suppresive treatments during autoimmune diseases (rheumatoid arthritis, lupus) 3. Infections (virus, bacteria, and parasites)

Answer 37

oligoclonal pattern

Question 38

TOF. Report an oligoclonal profile in gamma because multiple distortions are visible in gamma with inflammatory profile.

Answer 38

F (do not report)

Question 39

# TREATMENT WITH BETA MERCAPTOETHANOL TO DEPOLYMERIZE A MONOCLONAL Ig * Solution A of 1% BME reducing solution * Solution B of of 1% BME reducing solution * 25uL of solution B is mixed with how many mL of serum sample? * Incubation

Answer 39

* 10 uL BME + 90 uL h20 = Solution A * 10 uL solution A + 90 uL Fluidil (Ref 4587) = Solution B * 75mL * 10 minutes RT

Question 40

Congrats u've reached the end!

Answer 40

NOW DO EXERCISES ON CAPILLARY ELECTROPHORESIS INTERPRETATIONS >:( ## Footnote eme di pa pala tapos

Question 41

# Suggested investigation strategy for monoclonal gammopathies Analysis: * Inflammatory pattern * Nephrotic pattern * Double peak in a1 or a2 * Bisalbuminemia * Hemolyzed serum + Hyperlipemic serum * ß-y bridge * Known gammopathy Next estep?

Answer 41

estop envestigation

Question 42

# Suggested investigation strategy for monoclonal gammopathies * Peak or distortion in the Y zone * Significant increase in 1* or clear distortion in $1 * Significant increase or clear distortion in B2° * Isolated increase of B32 （632 = B1） * Isolated increase of a2 Next stpe is to IT (idk what it means sorry) Answer the following * If there's questionable pattern, next step is to? * If there's evidence of abnormality? * If there's absence of abnormality?

Answer 42

* Conclusion (after IF): SPE in 3-4 months * Gammopathy * Absence of Gammopathy

Question 43

Analysis: * Hypogamma without visible peak * History of gammopathy & no visible peak * Bence Jones protein in urine & no evidence of abnormality in serum * Slight isolated increase of 1ª or discrete distortion of ß1° or 2° * Slight isolated increase of a2° Next step: IF Answer the following * If there's doubtful pattern, next step is to? * If there's evidence of abnormality? * If there's absence of abnormality?

Answer 43

* SPE in 3-4 months * Gammopathy * Absence of Gammopathy