UNIVERSITY OF ZIMBABWE

FACULTY OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF LABORATORY AND INVESTIGATIVE SCIENCES

NAME: MAXWELL MUCHINI

REG NUMBER: R186508G

COURSE: CHEMICAL PATHOLOGY

LECTURER: DR ZHOU

DUE DATE: 11/04/22

Multiple Choice Questions
1. Match each of the following proteins with their function/s.
I= ADH, II=Thrombin, III=Protease, IV=Immunoglobins, V=Albumin
A=Transport, B= Maintaining plasma oncotic pressure, C=Defense, D= Enzyme, E=Clotting,
F=Hormone
I……………….….…II…………..………..II…………….……IV………….………..V………………………
2. Changes in plasma protein concentrations can be due to:
A T F overhydration
B T F septicaemia
C T F excessive protein loss via kidney
D T F severe sepsis
E T F kwashiorkor
3. The protein electrophoresis pattern of a plasma sample reveals an albumin peak in the region
containing
A T F α2-globulins
B T F Ceruloplasmin
C T F β-globulins
D T F γ-globulins
E T F α1-globulins
Hypoalbuminaemia causes the following effects
A T F Edema due to low oncotic pressure
B T F Movement of fluid into the interstitial spaces
C T F Reduced transport of drugs and other substances in plasma
D T F Reduced protein-bound calcium
E T F Drop in ionized calcium levels
5. Clinical Consequences of 1-antitrypsin deficiency include
A T F Neonatal jaundice with evidence of cholestasis
B T F Neural tube defect
C T F Childhood liver cirrhosis
D T F Down’s syndrome
E T F Pulmonary emphysema in young adults
6. Of the following, which are negative acute-phase proteins that decrease in inflammation?
A T F haptoglobin
B T F α1-antitrypsin
C T F CRP
D T F C3
E T F PSA
7. The protein electrophoresis pattern of a plasma sample reveals an 1-antitrypsin peak in the
region containing
A T F α2-globulins
B T F β1-globulins
C T F β2-globulins
D T F γ-globulins
E T F α1-globulins
8. Urinary excretion of Bence Jones proteins are generally associated with
A T F heavy chain gammopathy
B T F Myelomatosis
C T F multiple myeloma
D T F Waldenstrom’s macroglobulinaemia
E T F the dehydrated state
9. The following are positive acute phase reactants?
A T F 1-antitypsin
B T F haptoglobin
C T F ceruloplasmin
D T F fibrinogen
E T F c-reactive protein
10. The clinical applications of acute phase reactants include monitoring the following
A T F post-operative
B T F inflammatory bowel disease
C T F disorder inflammatory joint disease
D T F rheumatoid arthritis
E T F oncology
Essays
Distinguish the electrophoretic appearance of plasma protein of patients suffering from
hypergammaglobulinaemias and the acute phase of inflammation [25 marks].
Answer

Hypergammaglobulinaemia is a medical condition with elevated levels of gamma globulin. It is a

type of immunoproliferative disorder. It is divided into polyclonal hypergammaglobulinaemia

and monoclonal hypergammaglobulinaemia or paraproteinaemia. Polyclonal

hypergammaglobulinaemia occurs due to stimulation of many clones of B cells that produce a

wide range of antibodies. Gamma-globulin band appears large in electrophoresis. Clinical

conditions associated with polyclonal hypergammaglobulinaemia are acute and chronic

infections, autoimmune diseases and chronic liver diseases.

The following diagrams show the changes that occur in polyclonal hypergammaglobulinaemia.

The gamma globulin band appears large compared to the normal electrophoresis pattern due to

the production of many clones of B cells which produce a wide range of antibodies

immunoglobulins.
  

The above diagrams show the normal electrophoresis pattern.

This shows the widened region in polyclonal hypergammaglobulinaemia.

Monoclononal hypergammaglobulinaemia is caused by proliferation of a single B-cell clone produces a

single type of immunoglobulin. It appears as a separate dense band (paraprotein or M band) in

electrophoresis. Paraproteins are characteristic of malignant B-cell proliferation. Clinical conditions

associated with paraproteinaemia are multiple myeloma, myelomatosis, heavy chain disease and

Waldenstrom’s macrogloglobulinaemia. Monoclonal Hypergammaglobulinaemia or Paraproteinaemia

appears as a narrow dense band in g (mainly) and a2 regions on the electrophoresis strip.

This results from monoclonal proliferation of a particular B cell-produced by single clone of B cells

Acute phase proteins are classified as positive and negative acute phase proteins. Positive and negative

acute phase proteins are called acute phase reactants. They are synthesized due to body’s response to

injury. Examples include antitrypsin, haptoglobin, ceruloplasmin, fibrinogen, C-reactive protein (CRP),

complements, a1 acid glycoprotein. Positive acute phase proteins are a group of plasma proteins the
concentration of which increases as a response to the acute phase of inflammation such as Infection,

inflammation , malignancy, trauma, surgery, tissue breakdown and necrosis. . Increase in positive acute

phase proteins is mediated after injury by cytokines which include IL-6, TNF, interferons and platelet

activating factor. In Negative acute phase proteins are reduced in synthesis in the acute phase. Examples

include albumin, prealbumin and transferrin.

The diagram below shows electrophoresis pattern of positive acute phase proteins

The diagram below is an example of the electrophoresis pattern of transferrin a negative acute phase

protein.
The humoral effects of IL-1 and IL-6 include increased production of adrenocorticotropic hormone
(ACTH) and hence cortisol and decreased hepatic synthesis of albumin, prealbumin and transferrin.

Electrophoretic appearance of plasma proteins of patients suffering from:

Hypergammaglobulinaemias Acute phase of inflammation

gamma-globulin band appears large Gamma-globulin band appears large

No CRP response Increased CRP levels

Decrease in albumin level Decrease in albumin band

Alpha-1 increased Alpha-1 band increased
Alpha-2 bands increased Alpha-2 increased
REFERANCES

1. Zou L, Chen G, Zhou Y, Ye W, Wen Y, Chen L, Li X. Continuous hypergammaglobulinemia and

proteinuria after the recovery of the visceral Leishmaniasis: a case report. BMC Infect Dis. 2021
Jan 28;21(1):124. doi: 10.1186/s12879-021-05819-z. PMID: 33509123; PMCID: PMC7844912.
2. Choi KS, Kang JH, Cho HC, Yu DH, Park J. Changes in serum protein electrophoresis profiles and
acute phase proteins in calves with diarrhea. Can J Vet Res. 2021 Jan;85(1):45-50. PMID:
33390652; PMCID: PMC7747664.