Avashia J H, Walsh T D, Valenzuela R, Fernando Quevedo J, Clough J
Department of Hematology, Cleveland Clinic Foundation, Ohio 44195.
Cleve Clin J Med. 1990 May;57(3):298-300. doi: 10.3949/ccjm.57.3.298.
Paraproteinemia is an important diagnostic feature of multiple myeloma. The M-protein level reflects tumor burden and helps to determine the response to chemotherapy. A case is described that illustrates the phenomenon of reversible in vitro gelification of an M-protein. Paraprotein IgG1-kappa formed a concentration- and temperature-dependent gel, which was reversed by agitation. Measurement of paraprotein without previous vortexing of the specimen can erroneously lower the apparent M-protein level as well as reduce serum viscosity levels. This phenomenon can downstage the disease at diagnosis, produce inappropriate assessment of treatment response, or lead to premature withdrawal of chemotherapy. In addition, misdiagnosis of hyperviscosity syndrome can occur with serious clinical consequences.
副蛋白血症是多发性骨髓瘤的一项重要诊断特征。M蛋白水平反映肿瘤负荷，并有助于确定化疗反应。本文描述了一个病例，该病例说明了一种M蛋白的体外可逆凝胶化现象。副蛋白IgG1-κ形成了一种浓度和温度依赖性凝胶，通过搅拌可使其逆转。在未对标本进行先前涡旋的情况下测量副蛋白，可能会错误地降低表观M蛋白水平以及降低血清粘度水平。这种现象可能会在诊断时使疾病分期降低，对治疗反应产生不恰当的评估，或导致化疗过早停药。此外，可能会发生高粘滞综合征的误诊，从而产生严重的临床后果。
