The accepted most definitive and robust test is the absence or presence
of CSF-specific beta-2 transferrin (product of intrathecal
neurominadase), detected using electrophoresis and immunofixation with
anti-transferrin (available in our Department). In this particular case
would expect a clear cut result (negative?)....I expect that a colleague
closer to home can advise where this test is up and running.  Attached
is the reference article (in lab comm.) for your and other colleagues'
interest....what finally triggered her investigation after so many
years?

Best wishes, 			 

Tom Dembinski  PhD FCACB
Department of Clinical Biochemistry
Health Sciences Centre
820 Sherbrooke St
Winnipeg, Manitoba
Canada  R3A 1R9

204-787-4531  voice
204-787-3846  fax
[log in to unmask]

ps. Lab communication text follows in case you cannot open the word 7.0
file above: 

Please Post and/or Circulate

				     Department of
				     Clinical Chemistry MS-5
				     820 Sherbrook Street
				     Winnipeg, MB  R3A 1R9
				     Telephone (204) 787-2843
				     FAX #     (204) 787-3846


LABORATORY COMMUNICATION 
							         	March 1998

 Improvements to protocols for investigation of protein abnormalities

Screening, identification and monitoring of the monoclonal (M) protein
component of gammopathies has been available from Immunoprotein and
Clinical Chemistry laboratories, utilizing serum protein electrophoresis
(SPE) and urine protein electrophoresis (UPE), and immunoelectrophoresis
(IEP).  In addition, Clinical Chemistry has provided protein
electrophoresis (PE) analysis with interpretation for other clinical
situations unrelated to gammopathies (eg. proteinuria type
identification, screening for oligoclonal IgG banding in CSF).

Effective Monday, March 9 1998  these services will now be available
from an integrated laboratory unit to provide the most appropriate and
efficient testing protocols for these types of clinical investigation.
Specific details pertaining to service changes (in bold type) are listed
below.   

Monoclonal protein investigation
Screening:	1)  Submit serum (and ideally, in high clinical suspicion
cases, urine 10 mL)
 		2)  On requisition, order SPE (and UPE)
		3)  Write "? M band" in diagnosis  box on requisition

Monitoring:	Submit serum and/or urine (24hr specimen required for
meaningful comparison
between serial quantitations) with respective test orders (as above)

On M band-positive patients, monoclonal proteins will be typed and
abnormal immunoglobulin (Ig) and remainder of normal Igs quantitated.

Electrophoresis for other protein abnormality investigations

1)	Requests for SPE & UPE, first line screening tests for protein
pattern abnormalities, will
 receive regular interpretation and follow-up investigation for M
protein,
 if any irregularities are detected on PE.
2)	Requests for detection of oligoclonal IgG banding in CSF require 5mL
CSF and 1 mL serum 
in order to verify intrathecal IgG synthesis in CSF oligoclonal-positive
patients.
3)  	Requests for detection of beta-2 transferrin (the most reliable
laboratory test to identify CSF
	leakage) in nasal, ear or other fluids requires  submission of 2mL
fluid (min. vol., 1 mL).
	[reference:  Zaret et al., Clin Chem 1992; 38, 1909-1912]   

Please direct inquiries to any of the laboratory staff listed  below :
Ms. Sheila Ozamoto	      787-2156		Ms. Barb Holland	787-4622
Dr. Frixos Paraskevas	      787-2199		Mr. Mike Leroux	787-2845
Dr. Jim Dalton		      787-2452		Dr. Tom Dembinski	787-4531


>----------
>From: 	Michael Dr[SMTP:[log in to unmask]]
>Sent: 	Tuesday, August 18, 1998 9:02 AM
>To: 	[log in to unmask]
>Subject: 	rhinorrhoea vs CSF leak
>
>Dear Colleagues,
>
>We have a patient with rhinorrhoea for 16 years!!!! 'Experts' are divided
>over whether it is rhinorrhoea or CSF. Glucose is 3.0 mmol/L. Leakage only
>occurs when head tilted forward.
>
>Are there any definitive tests to distinguish between the source?
>
>Michael Ryan
>Antrim
>
>
>