Evaluation of the protein gap for detection of abnormal serum gammaglobulin level: an imperfect predictor

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Adam Suleman ◽  
D. William Cameron ◽  
Vicente Corrales-Medina ◽  
Christopher McCudden ◽  
Juthaporn Cowan
Keyword(s):  
Negative Predictive Value ◽  
Serum Protein ◽  
Total Protein ◽  
Predictive Value ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Likelihood Ratios ◽  
Paired Data ◽  
Predictive Values ◽  
Populations At Risk

AbstractObjectivesThe value of the serum protein gap (PG, difference between total protein and albumin) in the detection of hyper- or hypogammaglobulinemia is not well established. We assessed the performance of PG for the detection of hyper- or hypogammaglobulinemia in a large sample of patients.MethodsWe reviewed all paired measurements of serum total protein, albumin, quantitative immunoglobulins, and serum protein electrophoresis tested between March 2014 and June 2017 at the Eastern Ontario Regional Laboratory Association. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios of PG at thresholds between 18 and 44 g/L for the detection of hyper- and hypogammaglobulinemia were assessed.ResultsThere were 19,575 and 5,426 simultaneous paired data points to assess hyper- and hypogammaglobulinemia identified by serum protein electrophoresis (SPE) and nephelometry, respectively. The mean PG was 36.3 g/L (SD 8.6). The prevalence of hypergammaglobulinemia (>16 g/L by SPE) and hypogammaglobulinemia (IgG <7 g/L) was 21.9 and 5.5%, respectively. High PG (≥38 g/L) had sensitivity and specificity of 76.2 and 71.5% respectively for hypergammaglobulinemia. PG ≥38 g/L had a negative predictive value (NPV) of 93.1% for monoclonal, and 96.9% for polyclonal gammopathy. A PG threshold of ≤18 g/L had of sensitivity of 0.4%, specificity of 100%, PPV of 100% and NPV of 80.1% to detect hypogammaglobulinemia (IgG <7 g/L).ConclusionsHigh and low PG values were not sensitive in detecting hyper- or hypogammaglobulinemia, although negative predictive values were high for both. Performance of PG should be further evaluated prospectively in specific populations at risk of for abnormal IgG levels.

scholarly journals Volume of sputum to detect acid-fast bacilli as a measure of quality for the diagnosis of pulmonary tuberculosis at the Dr George Mukhari Hospital, South Africa

2011 ◽  
Vol 3 (1) ◽  
Author(s):  
Iqbal Rashid ◽  
Langalibalele H. Mabuza ◽  
Indiran Govender ◽  
Deidre Pretorius
Keyword(s):  
South Africa ◽  
Pulmonary Tuberculosis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
P Value ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Predictive Values ◽  
Acid Fast Bacilli

Background: Optimum sputum results for acid-fast bacilli (AFB) microscopy are linked to a sputum quantity of at least 5.0 mL. This study was aimed at establishing the effect of sputum quantity in the pick-up rate of AFB microscopy by comparing sputum samples of 5.0 mL and 2.0 mL.Methods: An analytical cross-sectional study was carried out at the Dr George Mukhari Hospital (DGMH) in Pretoria, South Africa, from 05 January 2007 to 04 January 2008.Two sputum samples, 5.0 mL and 2.0 mL, were collected from each of the 330 adult PTB (pulmonary tuberculosis) suspects. Fluorescence microscopy was used in the sputum analysis. The yield through microscopy of the 2.0 mL specimen versus the 5.0 mL specimen was compared and analysed, using culture results as the gold standard.Results: From a sample of 330 specimens, 77 tested AFB positive on microscopy. In the 5.0 mL samples, the sensitivity was 76.6% (95% CI, 66.0% – 84.7%), specificity 99.6% (95% CI 97.8% – 99.9%), positive predictive value (PV+) 98.3% (95% CI 91.1% – 99.7%), negative predictive value (PV-) 93.3% (95% CI 89.7% – 95.7%), the likelihood ratio (LR) for a positive microscopy 192 and the LR for a negative test was 0.23. In the 2.0 mL specimens, the sensitivity was 75.3% (95% CI 64.6% – 83.6%), specificity 99.2% (95% CI 97.1% – 99.8%), positive predictive value (PV+) 96.7% (95% CI 88.6% – 99.1%), negative predictive value (PV-) 93.0% (95% CI 89.3% – 95.4%), the LR for a positive microscopy was 94 and 0.25 for a negative microscopy. There was a statistically significant association (p-value < 0.001) between the microscopy and culture tests in both the 5.0 mL and the 2.0 mL specimen categories. The strength of association between the microscopy and culture, as indicated by the kappa test was 0.83 and 0.81 in the 5.0 mL and 2.0 mL categories, respectively.Conclusion: Compared to the 2.0 mL specimen category, the yield for AFB microscopy in the 5.0 mL specimen category was consistently superior, as indicated by the higher sensitivity, specificity, predictive values and the likelihood ratios in the 5.0 mL specimen category. It is recommended that sputum specimen collection for AFB microscopy should aim for a minimum volume of 5.0 mL.

scholarly journals ELEKTROFORESIS PROTEIN SERUM PASIEN DENGAN KADAR PROTEIN NORMAL

2018 ◽  
Vol 15 (3) ◽  
pp. 87
Author(s):  
Tiene Rostini ◽  
Coriejati Rita
Keyword(s):  
Serum Protein ◽  
Total Protein ◽  
Protein Level ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Total Protein Level ◽  
Normal Limits ◽  
Nephritic Syndrome ◽  
Serum Protein Level ◽  
Electrophoresis Pattern

Serum protein electrophoresis pattern can assist in diagnosis of liver disease, hematological disorders, renal disorders andgastrointestinal disease. Measurement of total protein level in the serum cannot detect any disorders in patient with normal limit ofserum total protein level. The aim of this study; was to evaluate the serum protein electrophoresis pattern in patient with normal limitsof serum protein level. This research was carried out by descriptive retrospective study using the electrophoresis data from patients’medical record at the Clinical Pathology Department, Dr. Hasan Sadikin General Hospital Bandung. The data of serum electrophoresis (bySebia gel electrophoresis) were grouped based on disease or disorders, and confirmed with the diagnosis derived from patient’s medicalrecord. Inclusion criteria of samples if ; the electrophoresis data were available, serum total protein level within normal limits (6.4–8.3mg/dL), and the data of electrophoresis taken from medical record were taken from August 2006 until August 2008. The result foundso far was, there were 240 data of electrophoresis from patients with serum protein level within normal limits (6.4–8.3 mg/dL). theinterpretation of electrophoresis consist of: 1) inflammation (149 patients; 62.2% ; sensitivity 83.7%, specificity 86,5%) 2) Cirrhosis(46 patients ; 19.2% ; sensitivity 87.5% ; specificity 88.4%) 3) Nephritic syndrome (15 patients ; 6.2%; sensitivity 53%; specificity96.9% 4) Monoclonal gammophaty (15 patients(6.2% ; sensitivity 80% ; specificity 98.7%) 5) Normal pattern in 15 patient (6.2%).This study found abnormal serum protein electrophoresis pattern in the condition of inflammation, Cirrhosis, Nephritic Syndrome, andMonoclonal gammophaty. It can be concluded that many disorders could be detected in patient with serum protein level within normallimits such as: inflammation, cirrhosis, nephritis syndrome and monoclonal gammophaty by abnormal electrophoresis pattern

scholarly journals Usefulness of serum globulin levels for discriminating patients with monoclonal gammopathies/ paraproteinemias

Biomedicine ◽  
2021 ◽  
Vol 41 (1) ◽  
pp. 31-35
Author(s):  
Neelam M Pawar ◽  
Anupama Hegde
Keyword(s):  
Serum Protein ◽  
Total Protein ◽  
Monoclonal Gammopathy ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Serum Globulin ◽  
Protein Ratio ◽  
Monoclonal Gammopathies ◽  
Median Serum ◽  
Control Study

Introduction and Aim: The confirmatory step in diagnosis of monoclonal gammopathies is bone marrow biopsy and presence of M-protein in serum protein electrophoresis. These tests are relatively expensive & invasive for screening and unavailable in low resource settings. Increased levels of serum globulin are clue to the diagnosis of monoclonal gammopathy. The aim of this study was to assess the relevance of serum globulin levels in discriminating between patients with & without monoclonal gammopathies/ paraproteinemia. Materials and Methods: We retrospectively reviewed serum protein electrophoresis (SPE) and related investigations of patients suspected of monoclonal gammopathy. Reports with an M-band were considered as paraproteinemias, and those without as controls. ROC for sensitivities & specificities for serum globulin levels were computed. Results: For the case-control study, median serum globulin values in cases were 4.4 (3.5-6.3) g/dL in males and 3.65 (3.33-5.0) g/dL in females. They were significantly higher than those with normal SPE pattern, with a p <0.001. A cut-off value of 3.25 g/dL of globulin could distinguish between paraproteinemias and controls with a sensitivity of 82.1% and specificity of 85.4% in males; a sensitivity of 79.2%, a specificity of 76.7% for females. At a cut-off value of 3.4 g/dL, sensitivity was 77% and specificity 92.7% for males; sensitivity was 75% and specificity 83.7% for females. Alternatively, a cut-off value of 0.458 of globulin/total protein ratio could distinguish at a best sensitivity & specificity of 80% and 89% in males; 83.3% and 83.7% in females. Conclusion: Serum globulin values and globulin/total protein ratio can reliably differentiate patients with paraproteinemias.

Prediction of Para-aortic Spread by Gross Pelvic Lymph Node Findings in Patients With Endometrial Carcinoma

2014 ◽  
Vol 24 (4) ◽  
pp. 697-702 ◽  
Author(s):  
Anna Luomaranta ◽  
Jouko Lohi ◽  
Ralf Bützow ◽  
Arto Leminen ◽  
Mikko Loukovaara
Keyword(s):  
Lymph Node ◽  
Endometrial Carcinoma ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Myometrial Invasion ◽  
Pelvic Lymphadenectomy ◽  
Pelvic Lymph Node ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Size And Morphology

ObjectiveIsolated para-aortic lymph node metastases are rare in patients with endometrial carcinoma. We wanted to determine the reliability of macroscopic pelvic lymph node findings at surgery in predicting para-aortic space involvement in these patients.MethodsWe identified all women with surgically treated endometrial carcinoma at our institution between January 2008 and February 2013 (n = 854). One hundred seventeen patients received pelvic-aortic lymphadenectomy. Lymph nodes were considered grossly positive based on size and morphology.ResultsIn patients who underwent comprehensive lymphadenectomy, grossly positive pelvic nodes predicted para-aortic metastasis with a sensitivity of 52.4% and specificity of 93.8%. The positive and negative likelihood ratios were 8.4 and 0.51, respectively. The predictive power of grossly positive pelvic nodes remained significant (odds ratio, 18; 95% confidence interval, 4.1–78; P < 0.0001) after correcting for deep myometrial invasion, poor tumor differentiation, and nonendometrioid histology as confounders. The whole sample of 854 patients was used for Bayesian calculations. The cutoff for a clinically useful test was set at the negative predictive value of 98.0%. The negative predictive value of the test (ie, grossly positive pelvic nodes at surgery in predicting the likelihood of para-aortic metastasis) was 99.7% for patients with superficial grade 1 to 2 endometrioid carcinomas and 98.0% for patients with deeply invasive grade 1 to 2 endometrioid carcinomas. For patients with grade 3 endometrioid and nonendometrioid carcinomas, the negative predictive values were 97.3% and 92.2%, respectively. For the whole study population, the value was 98.4%.ConclusionsWhen uterine factors are used for risk stratification of endometrial carcinomas, selective para-aortic lymphadenectomy, based on gross findings of pelvic nodes, is feasible for patients with grade 1 to 2 endometrioid carcinomas, regardless of the depth of myometrial invasion. Similarly, gross findings of pelvic nodes can be used to evaluate the need for para-aortic lymphadenectomy in the strategy of routine pelvic lymphadenectomy.

scholarly journals Seasonal influence on biochemical profile and serum protein electrophoresis for Boa constrictor amarali in captivity

2011 ◽  
Vol 71 (2) ◽  
pp. 517-520 ◽  
Author(s):  
LFN Silva ◽  
CCM Riani-Costa ◽  
PRR Ramos ◽  
RK Takahira
Keyword(s):  
Uric Acid ◽  
Serum Protein ◽  
Total Protein ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Seasonal Influence ◽  
Boa Constrictor ◽  
In Captivity ◽  
Different Seasons ◽  
The Mean

Similarly to other reptiles, snakes are ectothermic animals and depend exclusively on the environment for the maintenance of their physiological, biochemical and immunological processes. Thus, changes in biochemical values can be expected due to seasonal influence. Twenty-two adult specimens of Boa constrictor amarali kept in captivity were used. Blood collections were done in two different seasons: winter (July 2004) and summer (January 2005) for the following assays: uric acid, aspartate aminotransferase (AST), glucose, cholesterol, total protein, and serum protein electrophoresis. The mean biochemical results found in summer and winter, respectively, were: 6.3 ± 3.4 and 11.3 ± 6.2 mg/dL for uric acid; 28.7 ± 12.4 and 20.7 ± 16.2 UI/L for AST; 26.3 ± 17 and 17.4 ± 6.8 mg/dL for glucose; 67.3 ± 30.2 and 69.7 ± 38.5 mg/dL for cholesterol; and 5.9 ± 1.6 and 5.9 ± 1.4 g/dL for total protein. Results regarding electrophoresis in summer and winter, respectively, were: 1.9 ± 0.7 and 2.4 ± 0.6 g/dL for albumin; 0.7 ± 0.2 and 0.5 ± 0.2 g/dL for α-globulin; 1.5 ± 0.5 and 1.7 ± 0.6 g/dL for β-globulin; and 1.8 ± 0.5 and 1.5 ± 0.5 g/dL for g-globulin. In the summer, there was a significant increase in AST and a decrease in uric acid (p < 0.05). Serum protein electrophoresis showed a significant increase in α-globulin fraction (p < 0.05) in the same season. There were not significant differences between seasons for the remaining variables. Based on these results, the period of the year must be considered in the interpretation of some biochemical values for these animals.

Detection of gammopathy by serum protein electrophoresis for predicting and managing therapy of lymphoproliferative disorder in 911 recipients of liver transplants

Blood ◽  
2001 ◽  
Vol 98 (5) ◽  
pp. 1332-1338 ◽  
Author(s):  
Antoinette Lemoine ◽  
Patrick Pham ◽  
Daniel Azoulay ◽  
Faouzi Saliba ◽  
Jean-François Emile ◽  
...  
Keyword(s):  
Serum Protein ◽  
Lymphoproliferative Disorder ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Liver Transplants ◽  
Predictive Values ◽  
Chemotherapy Administration ◽  
Anti Cd20 ◽  
A Prospective Study

Monitoring of posttransplantation lymphoproliferative disorder (LPD) is usually based on imaging, which lacks sensitivity. A prospective study in 911 consecutive recipients of liver transplants was conducted to assess the value of gammopathy monitoring by serum protein electrophoresis (SPE) and to compare it with conventional follow-up methods. Patients systematically underwent SPE testing just before transplantation, at least twice during the first year after transplantation, and once a year thereafter. Patients with LPD underwent SPE testing every month. Immunofixation was done if abnormalities were detected by SPE. Gammopathy was observed in 114 patients, 18 of whom had onset of LPD. In 3 other patients, LPD developed, but no gammopathy was detected before onset of LPD or while LPD was present. Multivariate analyses showed gammopathy (relative risk [RR], 65.3), more than one transplantation (RR, 7.5), and viral cirrhosis (RR, 2.8) to be independent prognostic factors associated with occurrence of LPD. LPD was treated by reducing immunosuppression, with or without chemotherapy, administration of anti-CD20 monoclonal antibody, or surgery. The mortality rate was 24% (5 of 21 patients). Remission, which occurred in 13 patients, was associated with disappearance of gammopathy in 10 patients. In 5 patients, normalization of SPE results preceded the diagnosis of remission based on imaging, by a mean of 4 months. For diagnosis of LPD remission, the positive and negative predictive values of disappearance of gammopathy were 91% and 100%, respectively; and gammopathy monitoring was more sensitive than imaging (100% and 38%, respectively). Gammopathy monitoring is an inexpensive, noninvasive, sensitive way to detect LPD and assess the efficacy of treatment. It could be used routinely in follow-up of recipients of transplants.

scholarly journals Diagnosing Paraproteinemic Keratopathy: A Case Report

2021 ◽  
pp. 337-343
Author(s):  
Eugenie Mok ◽  
Ka Wai Kam ◽  
Anthony J. Aldave ◽  
Alvin L. Young
Keyword(s):  
Optical Coherence Tomography ◽  
Genetic Testing ◽  
Serum Protein ◽  
Molecular Genetic ◽  
Anterior Segment ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Optical Coherence ◽  
Molecular Genetic Testing ◽  
Corneal Opacities

A 65-year-old man presented with bilateral, painless, progressive blurring of vision over 9 years. Slit-lamp examination revealed bilateral subepithelial corneal opacities in clusters located at the mid-periphery. Anterior segment optical coherence tomography, in vivo confocal microscopy (IVCM), serum protein electrophoresis, and molecular genetic testing were performed to evaluate the cause of corneal opacities. Anterior segment optical coherence tomography revealed a band-like, hyperreflective lesion in the Bowman layer and anterior stroma of both corneas. IVCM revealed hyperreflective deposits in the epithelium, anterior stroma, and endothelium. Serum protein electrophoresis identified the presence of paraproteins (immunoglobulin kappa), and molecular genetic testing revealed absence of mutations in the transforming growth factor beta-induced gene (<i>TGFBI</i>) and collagen type XVII alpha 1 gene (<i>COL17A1</i>). The ocular diagnosis of paraproteinemic keratopathy eventually led to a systemic diagnosis of monoclonal gammopathy of undetermined significance by our hematologist/oncologist. Paraproteinemic keratopathy is a rare differential diagnosis in patients with bilateral corneal opacities and therefore may be misdiagnosed as corneal dystrophy or neglected as scars. In patients with bilateral corneal opacities of unknown cause, serological examination, adjunct anterior segment imaging, and molecular genetic testing play a role in establishing the diagnosis.

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