proteins and paraproteinemia

Question 1

what is the difference between serum and plasma?

Answer 1

in serum fibrinogen is removed

in plasma fibrinogen is still present

Question 2

what are the major contributors to serum protein ?

Answer 2

albumin and immunoglobulins

Question 3

what are the factors that increase serum protein ?

Answer 3

haemconcentration

increased synthesis

Question 4

what are the factors that decrease serum protein ?

Answer 4

haemdilution
renal loss
gut loss
redistribution

Question 5

what does serum electrophoresis separate ?

Answer 5

separates protein based upon size and charge

Question 6

what must be used in electrophoresis ?/

Answer 6

serum not plasma

Question 7

how many bands does serum separate into ?

Answer 7

normal serum separates into five bands

Question 8

what is the most abundant plasma protein ?

Answer 8

albumin

Question 9

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

Answer 9

Albumin

Question 10

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

Answer 10

alpha 1 globulin
alpha 2 globulin
beta globulin
gamma globulin

Question 11

what does the alpha 1 globulin band consist of ?

Answer 11

alpha 1 antitrypsin

Question 12

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

Answer 12

increased in:
acute phase reactions
decreased in:
inherited deficiency

Question 13

what happens to albumin levels in acute phase reactions ?

Answer 13

decreased levels

Question 14

what does the alpha 2 globulin band consist of ?

Answer 14

alpha 2 macroglobulin
haptoglobulins
lipoproteins

Question 15

when are the alpha 2 globulins increased?

Answer 15

acute phase reactions
nephrotic syndrome
chronic infections

Question 16

what are the function of haptoglobulins ?

Answer 16

they bind free haemoglobin

Question 17

when are haptoglobulins levels affected ?

Answer 17

increased in acute phase reactions

decreased in intravascular haemolysis

Question 18

what is the structure of immunoglobulins ?

Answer 18

consist of a light chain and a heavy chain

Question 19

immunoglobulins monoclonal or polyclonal ?

Answer 19

polyclonal

Question 20

what is the cause of hypergammaglobulinaemia ?

Answer 20

chronic major infection
chronic liver disease
autoimmune disease
sarcoidosis

Question 21

high igA is characteristic of ?

Answer 21

liver disease

Question 22

what is paraproteinemia ?

Answer 22

the presence of monoclonal immunoglobulin band in the serum

Question 23

what does a plasma cell look like histologically ?

Answer 23

eccentric nucleus
cartwheel appearance
surrounded by a lighter area

Question 24

what is the main cause of M-Protein ?

Answer 24

MGUS
Multiple Myeloma
AL amyloidosis

Question 25

what is a myeloma ?

Answer 25

cancer of plasma cells

Question 26

what is the clinical presentation of multiple myeloma ?

Answer 26

``` hypercalcaemia renal failure anemia bone pain and pathological fractures hyper viscosity ```

Question 27

what are the screening test done for multiple myeloma ?

Answer 27

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

Question 28

what are bence jones proteins

Answer 28

immunoglobulin light chain that is found in urine

Question 29

when are monoclonal free light chains found ?

Answer 29

found in serum when GFR is compromised | likely to be missed if serum is only tested urine must also be tested

Question 30

what are the diagnostic investigations for multiple myeloma?

Answer 30

``` 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 ```

Question 31

after diagnosing multiple myeloma what is important to identify next ?

Answer 31

the type of immunoglobulin ( IgA, IgG...)

Question 32

what is immunofixation ?

Answer 32

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

Question 33

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

Answer 33

rouleaux formation

Question 34

what are the laboratory findings in multiple myeloma ?

Answer 34

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

Question 35

when are proteins in the CSF elevated ?

Answer 35

with infection contamination from blood chronic inflammatory disorders tumors

Question 36

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

Answer 36

look for CSF xanthochromia

Question 37

what does xanthochromia mean ?

Answer 37

presence of bilirubin in the CSF

Question 38

when should the CSF sample for xanthochromia be taken ?

Answer 38

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

Question 39

when are oligoclonal bands found in the CSF ?

Answer 39

in inflammatory CNS disorders such as in MS