Hi,
I would check if the paraprotein creates an interference by precipitating
out of solution during the reaction. I suggest that you look at the actual
absorption readings during the reaction (reaction monitor, or whatever it
is called on your analyzer) and compare it to other high protein readings.
Different sample types (serum vs plasma) may behave differently in this
aspect. Has it always been the same sample type ?
***************************************************************
Wolfgang Schneider, PhD, CSPQ, FCACB
Chef du service clinique de biochimie
Hôpital du Sacré-Coeur de Montréal
5400, boul. Gouin Ouest
Montréal, Québec H4J 1C5
Canada
Tél.: (514) 338-2222 x 2611
Courriel: [log in to unmask]
***************************************************************
De : "Williams Karen (RPA) Medway Trust"
<[log in to unmask]>
A : [log in to unmask]
Date : 2017-01-11 11:53
Objet : Intereference with total protein - any ideas?
Envoyé par : Clinical biochemistry discussion list
<[log in to unmask]>
Hi
We have a myeloma patient (IgG Kappa) who recently has TP results >100g/L
which we expected would be due to rising paraprotein.
23/11/16 20/9/16 21/6/16 9/2/16
TP g/L 117 109 100 91
Albumin g/L 37 37 36 36
Paraprotein 17.9 30.0 37.4 29.7
g/L
Paraprotein 15.3 27.5 37.4 32.6
%
Scan albumin 66.1! 49.8 40.1 39.5
g/L
Scan albumin 56.5 45.7 40.1 43.4
%
Visually the electrophoresis scans look as you would expect, the sample
from 23/11/16 the paraprotein band looks narrower than the previous sample
and the peak is much lower compared to albumin than on the previous scan.
Normally our scanned albumin results are close to the measured albumin
results.
All of which leads us to believe the problem is with the TP result not the
electrophoresis. We don’t usually see interference from the paraprotein
itself on the TP assay and have other patients with TP of this order which
don’t look like this.
We have had a sample today, TP is 119g/L, on dilution results are linear.
We haven’t run electrophoresis on it yet.
Patient is on Bisoprolol, Oxazepam, Aspirin, Solifenacin, Lansaprazole,
Bendroflumethiazide.
I have now found a second patient which looks suspiciously similar, TP
yesterday 102g/L PP 24g/L previous TP 86g/L PP also 24g/L visually on the
scan the paraprotein has gone down on the most recent sample with the high
TP.
Any ideas?
Thanks
Karen
Karen Williams
Clinical Biochemist
Biochemistry, Pathology
Diagnostics
Medway NHS Foundation Trust
01634 830000 Ext 5419/5244
Please note I work part time, my normal working days are Monday, Tuesday
and Wednesday
Website: www.medway.nhs.uk
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