Index Case 1 An 88-year-old hypertensive man with multiple myeloma was admitted to our hospital because of a right lower lobe pneumonia. Common Treatments for Amyloidosis The treatment of amyloidosis varies depending upon the type and how the disease manifests in particular organs. The sera were free of hemolysis, icterus, and lipemia by routine index checks on automated analyzers. Then paraprotein was added and the maximal achieved aggregation curve elevation and latent period were determined again. Platelet Aggregation Platelet aggregation was measured by Born's optical method, using whole blood aggregometer model 560.
Recently one laboratory reported success using a new function to detect abnormal reaction data on an automated chemistry analyzer. The vertical bars indicate the initial and final reading times used to calculate results. The maximal achieved aggregation curve elevation and latent period until the beginning of aggregation were measured. A process similar to immunofixation but adapted for capillary electrophoresis systems has recently been developed. Remember to consider charge when you determine the formulas for the possible products.
Platelet aggregation disorder was established for all ten patients. Based on our series of patients with monoclonal gammopathies, the incidence of paraproteins interfering with the Roche total bilirubin assay is very low. After the beads settle, capillary electrophoresis is performed on the supernatant. This was repeated until the cold agglutinin activity in the supernatant was negative. The characteristics of these monoclonal antibodies were defined in a collaborative study of the World Health Organization. Clin Chem Lab Med 2001. Serum from both index patients was anicteric, their direct bilirubin measurements were unaffected, and total bilirubin measured using an alternate assay was normal.
Isolated paraprotein from each patient had its own healthy control. We describe 2 patients with paraproteinemia and elevated total bilirubin levels measured erroneously using the Roche total bilirubin assay. Physical examination was otherwise unremarkable. Thus, platelet aggregation was decreased with all inducers used, but each patient had a normal platelet count. The sample was applied to six different lanes on an agarose gel, and proteins were separated by electrophoresis. There is typically less loss than with filtration. The latent period from the moment of adding the agonist till the beginning of aggregation was measured as well, where 1 sec corresponded to 1 mm on the aggregation graphic record.
For all patients, serum IgG, IgA, IgM, total and direct bilirubin, creatinine, and an I index were determined on the Hitachi 917 instrument. Raveschot for expert technical assistance. If it is not crystals, you can adjust the bottom lighting you can easily see precipitate as a cloudy drop and try pushing the pH, salt or other additives up or down by pulling a liquid thread connecting with drops of different solutions. The likelihood of this interference in most of these reports was also unrelated to either the paraprotein type or concentration. Eur J Clin Chem Clin Biochem 1994. Each result was then compared with the corresponding I index for that specimen. Serum protein electrophoresis and immunofixation electrophoresis revealed a monoclonal IgM-κ.
Small monoclonal components can also be the cause of amyloidosis or polyneuropathy, or they may be the clue to autoimmune or immune complex diseases. To circumvent the difficulties encountered in conventional affinity chromatography, novel affinity-based protein purification processes using reversible protein-ligand interactions have been developed. Proteins were measured by direct absorption at 214 nm through a small optical window in the capillary. The sample incubation and running temperature in the Paragon 2000 was 24 °C. So far, my kidney function is considered stable, but it could easily dip down into the below normal range, so I have to have frequent checkups. Cystocentesis is the preferred collection method, although catheterized samples and clean free catch are considered acceptable.
If artifactual elevation of total bilirubin is suspected, the laboratory should examine the specimen for icterus manually or by spectrophotometry or measure total bilirubin using a different method. Using a multidisciplinary approach, our physicians have extensive experience treating these rare diseases, and are committed to providing outstanding, individualized patient care. If there is a precipitation reaction, write the complete and net ionic equation that describes the reaction. Lets divide these values by 100 to get the precipitation time series in inches. General Steps Step 1: Determine the formulas for the possible products using the general double displacement equation.
The specific immunoglobulin component is unassociated kappa or lambda light chains. During electrophoresis, paraproteins move as a compact fraction, depending on the isotype variant of the immunoglobulin. The latent period until the beginning of aggregation and the final level of aggregation were measured after incubation at 37°C. In order to exclude the possibility of nonspecific binding of paraproteins to the platelet receptors in vitro, the platelet aggregation test was repeated with added immunoglobulins for intravenous application. Although small monoclonal components are commonly part of a monoclonal gammopathy of undetermined significance or reflect the presence of an infectious disease, they may also be part of clinically important processes such as B-cell lymphoma, leukemia, chemical immunosuppression, or myeloma light-chain disease.
The most common problem reported with immunofixation electrophoresis is that it also detects intact immunoglobulins in the urine that are unassociated with Bence-Jones protein. Sample Requirements for Urine Protein Electrophoresis Submit 10 ml of urine in a sterile leak proof container or red top serum tube on ice packs to the testing laboratory. The patient's serum contained a monoclonal IgM kappa, a cryoglobulin and a cold agglutinin. The arrow indicates the free light chains, which can be noted in the control A and the electropherogram after incubation with the IgG binder B but not in the electropherogram after incubation with the light chain binder C. In this disease, amyloid protein deposits accumulate very slowly over time, occurring in elderly patients. As protein concentrations increases, packing of protein molecules will increase by the increase in the number of protein:protein interactions.