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Question

Dave's serum was analysed by capillary zone electrophoresis with a UV detector set at 210nm and a large potential paraprotein was seen (shaded in panel A). Subsequent immunofixation studies (not shown) suggested that the paraprotein might be an artefactual pseudoparaprotein. Dave's serum (2) was compared to that of a healthy patient (1) by agarose gel electrophoresis (panel B, stained with acid violet 17) and his serum was sampled again after 5 days and analysed by CZE, Panel C).

Summarise and discuss this evidence from a technical standpoint and present a likely identity for a pseudoparaprotein (6 marks).

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Answer 1

Paraproteins are usually produced in proliferative blood disorders like myeloma. Since the peak in Daves CZE was transient, the original peak was probably not a true paraprotein peak (hence called a pseudoparaprotein). Since paraproteins are a form of immunoglobulin, the immunofixation also supports this. Finally comparison of Dave's serum with a "normal" patient by agarose gel electrophoresis and stained with acid violet shows only minor differences (not clear whether Dave's sample here was day 0 or day +5). A number of candidate proteins have been determined to cause this effect: Beta lipoprotein, transferrin, fibrinogen, C-reactive protein, and hemoglobin-haptoglobin complex in hemolyzed samples.