1. IMMUNOCHEMISTRY PROFILES Dr. Thomas Williams

2. TESTS DISEASES CASES

3. PARAPROTEIN MONOCLONAL PROTEIN M PROTEIN PROTEIN SPIKE M SPIKE

5. TESTS

7. Serum Protein Electrophoresis: Uses Protein Profile 1.General Medical Diseases 2.Defect Dysproteinemias 3.Humoral Immunodeficiency 4.Paraprotein Detection

17. Quantitative Assays: Uses 1.Confirm protein abnormalities suspected by serum protein electrophoresis 2.Monitor or follow known conditions 3.Confirm clinically suspected conditions 4.Identify paraproteins noted by electrophoresis 5.Says “Nothing” about monoclonality of immunoglobulins measured

21. Immunofixational Electrophoresis/ Immunoelectrophoresis: Qualitatively Identifies Proteins Paraproteins: Heavy and light chains Other proteins

27. Diseases – General Medical (Non-Paraprotein Associated)

28. Acute Phase Reactants  Haptoglobin Alpha, -Antitrypsin Alpha, -Acid Glycoprotein C-Reactive Protein C3 Ceruloplasmin  Albumin Transferrin Prealbumin

41. Selective Deficiencies Must Do Quantitative Assays

42. Diseases: Paraprotein Associated

43. MGUS

46. Multiple Myeloma

49. > 2 g/dL spike (or 3 g/dL) < Normal Immunoglobulins 5-10% or > Marrow plasma cells Bone lesions Anemia Other

52. Waldenstrom’s Macroglobulinemia

53. IgM Monoclonal Gammopathy (“Macroglobulinemia of Waldenstrom”) 80%:Fatigue, weakness, weight loss, lymphadenopathy, hepatosplenomegaly. Lymphocytes, plasmacytoid lymphocytes, plasma cells, admixed large cells. 1 in 10 develops localized or terminal disseminated large cell lymphoma. 10%:CLL with or without appreciable plasmacytoid features. 10%:Classic multiple myeloma with neoplastic plasma cells predominating.

54. IgM Monoclonal Gammopathy (“Macroglobulinemia of Waldenstrom”) Common to all:  Reduced levels of other Ig classes.  + bleeding diathesis, + visual disturbances and ocular abnormalities  + cold agglutinins (Raynaud’s syndrome, pupura), + hyperviscosity  B-J proteinuria usually at low level. Amyloidosis < 10%

57. Hyperviscosity Syndrome Symptoms include chronic nasal bleeding and oozing from the gums, blurring or loss of vision, dizziness, headaches, vertigo Most patients have symptoms when the relative serum viscosity reaches 6 or 7 (normal less than 1.8)

58. Hyperviscosity Syndrome Continued Most common causes of hyperviscosity syndrome are macroglobulinemia of Waldenstrom and IgA myeloma Treatment consists of plasmapheresis

59. Alpha, Mu, Gamma Heavy Chain Disease

63. Cases

72. Serum MG Evaluation SPE + IEP SPE + IFE SPE + QUANT Ig (WITH K/L) +/- IFE/IEP QUANT Ig WITH K/L OTHER