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Lymphadenopathy: Serum Protein Electrophoresis – White Blood Cell Pathology

by Carlo Raj, MD
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    00:01 With serum protein electrophoresis, a quick word or two about each one of the other zones so that you’re familiar and you don’t miss questions unnecessarily.

    00:10 I want you to go back and take a look at the normal serum protein electrophoresis and on the electrophoresis, I want you to identify alpha-1 zone, okay? Now, when you say alpha-1 zone, you should automatically think about alpha-1 antitrypsin, okay? That should make your life a little bit easier.

    00:29 Now with alpha-1 antitrypsin, what does this mean? Well, a decreased band is seen in deficiency.

    00:33 It is decreased in nephrotic syndrome.

    00:36 And nephrotic syndrome, you’ll know that you’re losing quite a bit of protein, right? Quite a bit or albumin and perhaps even quite a bit of alpha-1 antitrypsin.

    00:45 So therefore, you expect there to be a decrease in the alpha-1 zone.

    00:50 In addition, if you lose enough, enough, enough of your alpha-1 antitrypsin at some point, well, emphysema, you know about elastase.

    01:01 If you find absolutely no alpha-1, this to you should indicate, “Oh, maybe” or, as far as you’re concerned, should heighten the suspicion of – Does my patient have alpha-1 antitrypsin deficiency? Alpha-1 zone, the number one enzyme that should come to mind is your alpha-1 antitrypsin.

    01:19 We’ve talked about this in greater detail.

    01:21 I’m referring to my gene, PI, protease inhibitor.

    01:30 I want you to go back and take a look at the serum protein electrophoresis.

    01:33 And this time, we have an alpha-2 zone, okay? So little zones that you want to make sure that you have an idea as to what they are.

    01:41 The alpha-2 zone is the – The abbreviation that I’ll be using here is alpha-2 macroglobulin or AMG.

    01:50 And more importantly, for you, in the discussion that we’ve had prior is haptoglobin, okay? When did we have a discussion of haptoglobin? Yes, we had with hemolytic anemias.

    02:03 And with hemolytic anemia, what type of hemolysis of the RBC resulted in influence or effect with a haptoglobin.

    02:15 Was it intra or extravascular? I’m pushing you here on purpose.

    02:20 Intravascular, remember? So intravascular hemolysis would then cause a decrease in haptoglobin.

    02:27 So haptoglobin is a suicide molecule, which binds with free hemoglobin.

    02:31 Therefore, if there was intravascular hemolysis, you could then expect a decrease in haptoglobin.

    02:38 Haptoglobin is raised as part of your acute phase reactant.

    02:41 Remember haptoglobin is one of those components or acute phase reactant that comes from the liver.

    02:48 And haptoglobin here is responsible for binding to hemoglobin and intravascular hemolysis, you can expect that haptoglobin to be decreased and this is then represented by which zone on serum protein electrophoresis? Good.

    03:00 Alpha-2 zone.

    03:02 A normal alpha-2 and elevated alpha-1 zone is a typical pattern in hepatic metastasis and cirrhosis.

    03:10 Another very important clinical aspect and application, if you find normal alpha-2 and an elevated alpha-1 zone, you’re thinking about metastasis.

    03:20 Make sure that you know how to deal with some of these other zones of the serum protein electrophoresis apart from our discussion here focusing upon the gamma wave.

    03:30 Students tend to forget about these zones.

    03:33 There’s one more zone left, what is that called?


    About the Lecture

    The lecture Lymphadenopathy: Serum Protein Electrophoresis – White Blood Cell Pathology by Carlo Raj, MD is from the course Lymphadenopathy – White Blood Cell Pathology (WBC).


    Included Quiz Questions

    1. Nephrotic syndrome
    2. Pregnancy
    3. Appendicitis
    4. Multiple myeloma
    5. Malignant lymphoma
    1. Normal alpha 2 and elevated alpha 1
    2. Elevated alpha 1 and normal gamma
    3. Elevated beta 1 and normal alpha 2
    4. Elevated alpha 1 and alpha 2
    5. Elevated alpha 1 and normal beta 2

    Author of lecture Lymphadenopathy: Serum Protein Electrophoresis – White Blood Cell Pathology

     Carlo Raj, MD

    Carlo Raj, MD


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