Degenerative Diseases of the Nervous System
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
As described in the section on AD. With suspicion for VaD, consider addition of the following: Lipid panel.Hemoglobin A1c.Antinuclear antibodies.Serum protein electrophoresis.Coagulation studies (younger patients).Antiphospholipid antibodies.Proteins C and S.Antithrombin III.Factor V Leiden mutation.
The role of biochemistry and serology in pain diagnosis
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
Serum protein electrophoresis is primarily used to identify patients with multiple myeloma and other serum protein disorders. The proteins are separated based on their physical properties. A homogeneous spike-like peak in a focal region of the gamma-globulin zone indicates a monoclonal gammopathy, which is associated with a clonal process that is malignant or potentially malignant, including multiple myeloma and Waldenstrom’s macroglobulinemia.1 In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process.1
The back
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
FBC and ESR help screen for non-mechanical causes of lower back pain such as infections, inflammatory conditions and neoplasms. In elderly patients a serum protein electrophoresis and prostate-specific antigen in males should be part of the workup.
A case report of recurrent Well’s syndrome masquerading as cellulitis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Anum Qureshi, Jasmine Manley, Tristan Flack, Mark H. Lowitt
Two weeks after completing glucocorticoid therapy, she returned to the emergency department with complaints of severe back pain as well as recurrent cellulitis (lower extremities, groin, and perianal) with lower extremity edema. Significant laboratory findings included eosinophilia (11%). ANA, immunoglobulin panels, inflammatory markers, chemistries, and flow cytometry were normal. Serum protein electrophoresis revealed an elevated alpha-2 globulin fraction, but no monoclonality. She was again treated with parenteral then oral corticosteroids. Back pain was attributed to a musculoskeletal cause. Hematology and rheumatology consultants found no underlying abnormalities that could be associated with Well’s syndrome. Prednisone was again tapered over weeks, and she declined additional possible steroid sparing agents. She was free of active disease for fivemonths. Five months, later she had trauma to the left arm that led to severe arm redness, bruising and skin tear [Figure 4(a)] that initially healed, but later, she developed severe pain, redness at the site of injury (Figure 4(b)) and her symptoms were similar to the previous WS flare; she was treated with steroid and symptoms improved significantly and successfully tapered off steroids in fourweeks.
Proliferative glomerulonephritis with monoclonal immunoglobulin deposits of lambda chains
Published in Baylor University Medical Center Proceedings, 2018
Muhammad A. Panezai, Pingchaun Zhang, Gates B. Colbert
A 75-year-old white man with hypertension, coronary artery disease, and peripheral vascular disease was admitted with azotemia, fatigue, anorexia, and headaches. Admission laboratory values revealed a serum creatinine of 4.1 mg/dL and blood urea nitrogen of 95 mg/dL. His creatinine and blood urea nitrogen had been 1.1 mg/dL and 18 mg/dL 12 days prior. He reported no history of contrast exposure, nonsteroidal antiinflammatory use, or antibiotics. Vital signs were within normal limits. Urinalysis showed 100 red blood cells per high-powered field, 30 to 50 white blood cells per high-powered field, and a urine protein-creatinine ratio of 1.3. A renal ultrasound was within normal limits. Hepatitis B and C, antinuclear antibody, double-stranded deoxyribonucleic acid, anti-Sjögren syndrome A and B, anti-neutrophil cytoplasmic antibody, anti-glomerular basement membrane antibody, and cryoglobulins were all negative. Complement levels showed a normal C4, although C3 was low at 63 mg/dL (normal range, 90–180). Serum protein electrophoresis showed decreased total protein and no M spike. Serum immunofixation revealed normal-range levels of IgG (1007 mg/dL), IgA (276 mg/dL), and IgM (51 mg/dL), with very faint monoclonal lambda immunoglobulins present. Serum free kappa and lambda light chains were mildly elevated but with a normal free kappa-lambda ratio of 1.66. Urine protein electrophoresis showed a positive M spike of 5.5 mg/dL. Hemodialysis was initiated with a tunneled catheter for uremia.
A case of immunotactoid glomerulopathy in a patient with monoclonal gammopathy of renal significance
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Victoria Campdesuner, Yeshanew Teklie, Natalia Lattanzio, Christian Lorenzo, Stephen Bell, Yorlenis Rodriguez, Ashok Sastry
The diagnosis of MGRS requires renal biopsy and identification of the monoclonal protein in the serum and/or urine, as well as identification of the clonal population of cells that secrete said protein [1]. Kidney biopsy is performed with immunofluorescence (IF) and electron microscopic (EM) studies, which allow for identification of the type of MGRS lesion and the severity of renal disease [3]. Serum protein electrophoresis (SPE) and urine protein electrophoresis confirm the presence of a circulating monoclonal protein that corresponds to that identified via renal biopsy. Unfortunately, serum protein electrophoresis may not detect low levels of M-protein. Hence, serum immunofixation electrophoresis (IFE), urine IFE, and/or serum free light chain assay are performed due to their increased sensitivity [2]. Clonal cell population is identified via bone marrow aspiration and biopsy with identification of atypical lymphoid or lymphoplasmacytic cells or percentage of plasma cells [4]. In cases where a clonal cell population is not identified with bone marrow evaluation, imaging studies, such as CT, positron emission tomography (PET)-CT, or magnetic resonance imagining (MRI), can be performed to assess for lymphadenopathy or bone lesions, which should be biopsied [4].
Related Knowledge Centers
- Chronic Kidney Disease
- Globulin
- Hypercalcaemia
- Monoclonal Gammopathy of Undetermined Significance
- Proteinuria
- Blood
- Multiple Myeloma
- Electrophoresis
- Blood Protein
- Monoclonal Gammopathy of Undetermined Significance
- Syringe