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2 Lab Med Protein Student
2 Lab Med Protein Student
Protein Abnormalities
Prepared by:
4th year medical students
Revised by:
Dr. Ramez Zaid & Dr. Rihab Ibrahim
Assistant Professors
Pathology Department
Faculty of Medicine
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Introduction
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Types of plasma proteins:
A.Albumin (3.5 - 5.0 g/dL): about 50% of TSP.
G. lobulins (2 - 3.5 g/dl).
- α − globulins: α1& α2−globulins.
- β − globulins: β1 & β2 globulins.
- γ _ globulins (about 50% of globulins).
c.Others (as fibrinogen … etc)
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Serum Proteins Electrophoresis
■ Formerly widely used technique for the semi-quantitative
assessment of plasma proteins.
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Immunofixation Electrophoresis
(IFE)
▪ A specific type of electrophoresis used to detect important
proteins using specific antigens.
à Most commonly used to differentiate Monoclonal
hypergammaglobulinemia (that show narrow gamma band on
serum electrophoresis) from Polyclonal
hypergammaglobulinemia (that show wide gamma band on serum
electrophoresis).
▪ So we use specific antigens for the heavy chains (Ig G, A, M, D &
E) and for the light chains (kappa and lambda) to prove the
mono-clonality of hypergammaglobulinemia, which is called M –
protein or paraproteinemia.
❑On urine:
-To determine the cause of elevated urinary protein (as in nephrotic syndrome or
multiple myeloma …).
-When multiple myeloma is suspected.
❑On CSF:
-In multiple sclerosis to detect oligoclonal bands (multiple distinct bands in the CSF
seen in multiple sclerosis).
-Un-explained headaches or other neurologic symptoms to look for proteins suggestive
of inflammation or infection.
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Changes in TSP
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Hypoproteinemia
➢ Mainly occurs due to changes in albumin.
➢ Mechanism:
- ↓ oncotic pressure à ↑ ECF à edema.
- ↓ Renal flow à ↑ renin, angiotensin &
aldosterone à ↑ Na retention à ↑
hydrostatic pressure à edema.
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Causes of Hypoproteinemia:
■Notes:
-In
volume of distribution leads to relative decrease (Not a real decrease)
nephrotic syndrome TSP will be ↓ except for α2-macroglobulin which is not
lost in urine due to its large size.
-In liver failure TSP will be ↓ except for Ig A because it is synthesized in GI tract &
pregnancy , ascites
Artifactual
Sample taken from drip line 15
Hyperproteinemia:
à Rarely seen in clinical practice.
Increased synthesis
hypergammaglobulinemia and paraproteinemia
Notes:
-As you can see TSP is affected by:
Decreased volume of distribution
dehydration à Posture.
à Sample procedure.
Artifactual à State of hydration.
over infusion of albumin àConcomitant diseases.
hemoconcentration as in:
using tourniquet
upright posture after a period of recumbency
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1. Albumin:
■The most abundant plasma protein.
well.
2. α1-Antitrypsin:
■Anti-protease.
■↓ in intravascular hemolysis.
4. α2-macroglobulin:
■Anti-protease.
■↑ in nephrotic syndrome.
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5. Ceruloplasmin:
■A copper-carrying protein.
■↓ in Wilson's disease.
6. Transferrin:
■Iron-transporting protein, normally 30% saturated.
7. Immunoglobulins:
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2
0
Hypogammaglobulinemia
A. Physiological:
-Early in life Igs are low (except for Ig G, Why?) and ↑ with age.
B. Pathological:
➢Congenital (primary):
-X-linked agammaglobulinaemia (Bruton's disease), Selective IgA
deficiency, hyper-IgM with decreased IgG ...
➢Acquired (Secondary):
-Marrow replacement and inhibition leading to decreased number of
plasma cells as in malignant lymphoma, leukemia (↓ normal Igs) and
multiple myeloma (the abnormal monoclonal Ig ↑ while other Igs ↓
leading to recurrent infections.
-Protein-losing conditions (gut, kidney).
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Hypergammaglobulinemia
A.Polyclonal hypergammaglobulinemia:
-Acute and chronic infections (all Igs are increased).
B.Monoclonal hypergammaglobulinemia:
M-proteinemia or paraprotein:
A monoclonal immunoglobulin (identical heavy and light chain)
produced by a single clone of cells of the B-lymphocyte
(mostly plasma cells).
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➢ Multiple myeloma (MM):
- Paraproteinemia > 3 gram/dL (usually Ig G >> A >> M >>> E,D) with
osteolytic bone lesions, BM plasmacytosis, anemia, and hypercalcemia
… etc.
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2
4
➢ Monoclonal gammopathy of undetermined significance (MGUS):
- Seen in elderly > 70 yrs.
- Benign paraproteinemia
< 3 gram/dL (as in MM
but lower levels)
with no bone destruction
or other symptoms.
à γ-globulin (due to
chronic inflammation &
increased Ig A)
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à α1-globulins
à γ-globulin is almost
absent
(agammaglobulinemia)
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Polyclonal hypergammaglobulinemia
(broad γ-globulin band)
Monoclonal hypergammaglobulinemia
(narrow spike like gamma globulin band – IgG, lambda28restricted)
Acute Phase Response (APR)
■ It includes physiological changes that occur
following infection, inflammation, trauma,
burns … as:
- Hemodynamic changes.
- ↑ of coagulation and fibrinolytic activity.
- Leukocytosis.
- Pyrexia.
- Acute phase proteins or reactants;
à ↑ or ↓ in certain plasma proteins concentration
by at least 25 %.
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■ Positive acute phase reactants:
- Plasma proteins that ↑ in APR.
- Mainly due to the effect of IL-6 on the liver (↑ synthesis).
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1. C-reactive protein (CRP):
▪Have a general function in defense against bacteria and foreign
substances.
▪Can increase 30-fold from a normal value of less than 5 mg/L
during the APR.
▪It is more useful, sensitive and more specific than measurement of
the ESR (esp. in acute inflammation).
▪CRP begins to rise at about 6 h after the initiation of an acute phase
response and reaches a peak after about 48 h before beginning to fall.
▪Significant increase in CRP is seen in bacterial infections. While
viral and some autoimmune diseases (as SLE & scleroderma) do not
usually cause a raised CRP.
■Disadvantages:
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2. Erythrocyte Sedimentation Rate (ESR):
■It is the rate (mm/hr) at which RBCs suspended in plasma settle
when placed in a vertical tube à Common and simple test, BUT
less specific.
■Disadvantages:
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