Proteins Case Studies

72 year old presents with back pain, fatigue and anemia.

Labs:

total protein : 10.2 g/dL

↓ albumin

SPEP shows sharp spike in y region

immunofixation identifies IgG k

• IgG k multiple myeloma

A patient has bone pain and renal insufficiency but SPEP and IFE show no clear M spikes. UPEP has a large y spike. What is the likely diagnosis?

• Light chain myeloma

A patient has bone pain and renal insufficiency but SPEP and IFE show no clear M spikes. UPEP has a large y spike. What test will confirm the diagnosis?

• serum free k and ƛ chains with k/ƛ ratio

A 46 year old with leg edema and massive proteinuria

Labs:

total protein: 8.1 g/dL (high)

albumin: 1.9 g/dL (low)

cholesterol: 410 mg/dL

urine protein: 4+

SPEP:

• low albumin peak, huge a2 peak, supressed y region

UPEP:

• massive albumin peal, low globulins

• Nephrotic Syndrome

A 58-year old alcoholic presents with jaundice and ascites

SPEP:

• low albumin, fusion of B and y regions, broad elevation in y region

Labs:

• total protein: 7.6 g/dL

• albumin: 2.5 g/dL

• AST/ALT: 3.1 (elevated)

• INR: elevated

• Cirrhosis with Polyclonal IgA elevation

A 32 year old with pneumonia has a normal total protein.

SPEP:

• ↑ a1 and a2

• ↓ albumin

• normal y region

• acute inflammation/ acute- phase response

  • due to elevated acute phase reactants

A patient with stage 4 CKD has:

• k: 120 mg/L (high)

• ƛ: 90 mg/L (high)

• k/ƛ ratio: 1.50 (normal)

Does this indicate monoclonal gammopathy?

• No

  • both k and ƛ are elevated BUT ratio is normal

  • typical for reduced renal clearance in Chronic Kidney Disease