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ICC3 > proteins and paraproteinemia > Flashcards

proteins and paraproteinemia Flashcards

1
Q

what is the difference between serum and plasma?

A

in serum fibrinogen is removed

in plasma fibrinogen is still present

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2
Q

what are the major contributors to serum protein ?

A

albumin and immunoglobulins

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3
Q

what are the factors that increase serum protein ?

A

haemconcentration

increased synthesis

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4
Q

what are the factors that decrease serum protein ?

A

haemdilution
renal loss
gut loss
redistribution

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5
Q

what does serum electrophoresis separate ?

A

separates protein based upon size and charge

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6
Q

what must be used in electrophoresis ?/

A

serum not plasma

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7
Q

how many bands does serum separate into ?

A

normal serum separates into five bands

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8
Q

what is the most abundant plasma protein ?

A

albumin

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9
Q

what does the first main band in serum protein electrophoresis show?

A

Albumin

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10
Q

what does the second , third, fourth and fifth band in electrophoresis show ?

A

alpha 1 globulin
alpha 2 globulin
beta globulin
gamma globulin

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11
Q

what does the alpha 1 globulin band consist of ?

A

alpha 1 antitrypsin

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12
Q

when are the levels of alpha 1 antitrypsin increased and decreased?

A

increased in:
acute phase reactions
decreased in:
inherited deficiency

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13
Q

what happens to albumin levels in acute phase reactions ?

A

decreased levels

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14
Q

what does the alpha 2 globulin band consist of ?

A

alpha 2 macroglobulin
haptoglobulins
lipoproteins

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15
Q

when are the alpha 2 globulins increased?

A

acute phase reactions
nephrotic syndrome
chronic infections

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16
Q

what are the function of haptoglobulins ?

A

they bind free haemoglobin

17
Q

when are haptoglobulins levels affected ?

A

increased in acute phase reactions

decreased in intravascular haemolysis

18
Q

what is the structure of immunoglobulins ?

A

consist of a light chain and a heavy chain

19
Q

immunoglobulins monoclonal or polyclonal ?

A

polyclonal

20
Q

what is the cause of hypergammaglobulinaemia ?

A

chronic major infection
chronic liver disease
autoimmune disease
sarcoidosis

21
Q

high igA is characteristic of ?

A

liver disease

22
Q

what is paraproteinemia ?

A

the presence of monoclonal immunoglobulin band in the serum

23
Q

what does a plasma cell look like histologically ?

A

eccentric nucleus
cartwheel appearance
surrounded by a lighter area

24
Q

what is the main cause of M-Protein ?

A

MGUS
Multiple Myeloma
AL amyloidosis

25
Q

what is a myeloma ?

A

cancer of plasma cells

26
Q

what is the clinical presentation of multiple myeloma ?

A 
hypercalcaemia 
renal failure 
anemia 
bone pain and pathological fractures 
hyper viscosity
27
Q

what are the screening test done for multiple myeloma ?

A 
full blood count 
ESR plasma viscosity 
urea creatinine and calcium 
serum immunoglobulins 
total protein and albumin 
concentrated urine for Bence jones proteins
28
Q

what are bence jones proteins

A

immunoglobulin light chain that is found in urine

29
Q

when are monoclonal free light chains found ?

A

found in serum when GFR is compromised

likely to be missed if serum is only tested urine must also be tested

30
Q

what are the diagnostic investigations for multiple myeloma?

A 
1.first paraprotein must be quantified🍗
immunofixation of serum and urine 
serum free light chains
2.bone marrow infiltration by neoplastic plasma cells☠️
bone marrow aspirate
bone marrow trephine
 3.demonstrate lytic bone lesions 
skeletal survey
31
Q

after diagnosing multiple myeloma what is important to identify next ?

A

the type of immunoglobulin ( IgA, IgG…)

32
Q

what is immunofixation ?

A

immunofixation always for the detection and typing of monoclonal antibodies or immunoglobulins in serum or urine ( what type of IG)

33
Q

what may be seen in peripheral blood smear in multiple myeloma ?

A

rouleaux formation

34
Q

what are the laboratory findings in multiple myeloma ?

A 
high total protein 
paraprotein 
bence-jones proteins in urine
renal impairment 
hypercalcaemia 
anemia ( normochromic normocytic)
35
Q

when are proteins in the CSF elevated ?

A

with infection
contamination from blood
chronic inflammatory disorders
tumors

36
Q

if the CT scan used to detect subarachnoid haemorrhages is equivocal what is the next step in management ?

A

look for CSF xanthochromia

37
Q

what does xanthochromia mean ?

A

presence of bilirubin in the CSF

38
Q

when should the CSF sample for xanthochromia be taken ?

A

take a sample a minimum of 12 hours post suspected bleed to allow for released haemoglobin to be converted into haemoglobin

39
Q

when are oligoclonal bands found in the CSF ?

A

in inflammatory CNS disorders such as in MS

ICC3 (66 decks)

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