Serum cryoglobulins

From the results of the variety of studies undertaken, it now appears certain that no one single immunological factor is responsible for the various forms of heart diseases which are seen in populations in subtropical and tropical countries. Thus, in patients with endomyocardial fibrosis (EMF), rheumatic heart disease, or idiopathic cardiomegaly, heart antibodies were present in 42% and thyroid antibodies in 15% serum cryoglobulins were present in 74% of the patients but was more frequent in those patients who had EMF than in any of the other groups (VI). The suggestion was therefore made that patients with EMF were... 

Shihabi, Z. Analysis and general classification of serum cryoglobulins by capillary zone electrophoresis. Electrophoresis, 17, 1607, 1996. 

The cell-type-specific glycoproteinaceous antigen from human fibroblasts also appears in plasma it interacts with fibrin and appears in the serum cryoglobulin fraction associated with cryofibrinogen. ... 

Flo. 8. Immunoelectrophoretic pattern of serum from a patient with IgG myelomatosis. Note the area next to the top well, where there is a spontaneous precipitation of cryoglobulins in the agar gel, which remained in the gel even after extensive washing with saline. The massive increase of the abnormal precipitin line of the patient s serum in the top well is distinctly different from that of the normal precipitin line below antiserum as in Fig. 7. 

This syndrome is characterized by proteinuria >3.5 g/day, hypoalbuminuria <3 g/dl, hyperlip-idaemia with an elevation of serum cholesterol, edema and oval fat bodies and fatty casts in the urinary sediment. A variety of disorders may produce nephrotic syndrome but, in the majority of cases, no cause is found. It is appropriate to define the selection of studies from the history and physical examination. Tests to order are antinuclear antibody, rheumatoid factor, cryoglobulins, serum complement, HBsAg VDRL serology (syphilis), protein electrophoresis of the serum and urine and HIV. If the cause is unclear a renal biopsy is done to define the glomerular lesion as treatment may on the underlying glomerular lesion. 

Guidelines for clinical and laboratory evaluation of patients with monoclonal gammopathies have been proposed (K7). These proposals address in addition electrophoretic, immunofixation, and quantitative techniques for measurement of M protein, and also provide guidelines for serum viscosity and cryoglobulin measurements. 

Examination of cryoglobulins especially in patients with monoclonal IgM requires collection of at least 10 ml of blood into a prewarmed (to 37°C) tube or syringe, allowing the blood to clot at that temperature for 30-60 min prior to centrifugation to obtain serum. The serum sample should be stored at 4°C for up to 7 days. The presence of cryoglobulins in a formed precipitate should be confirmed by its solubility at 37°C, and further quantitated and characterized immunochem-ically (Kl). 

A 59-year-old man, who had taken amiodarone 200 mg/day for 2 years, developed fever, pleuritic chest pain, dyspnea at rest, a non-productive cough, malaise, and joint pains (211). He had a verrucous endocarditis and a pleuropericardial effusion. He had raised titers of antinuclear antibodies (1 320) with anti-Ro specificity. Serum complement was normal and there were no circulating immune complexes, no cryoglobulins, and no anti-dsDNA, anti-La, anti-Ul ribonucleoprotein, anti-Sm, anti-Scl, 70, anti-Jo 1, antihistone, antiphosphohpid, anticentromere, anticardioli-pin, or anticytoplasmic antibodies. Within 7 days of withdrawal of amiodarone the signs and symptoms started to resolve, and he recovered fuUy with the addition of prednisolone. 

Lerner, A. B., and Watson, C. J., Studies of cryoglobulins. I. Unusual purpura associated with the presence of a high concentration of cryoglobulin (cold pre-cipitable serum globulin). Amer. J. Med. Sci. 24, 410-415 (1947). 

Fig. 10.13 2D-PAGE Separation of a cryoglobulin isolated from serum of a patient with glomerulonephritis (left) and MALDI-FT-ICR-MS of tryptic in-gel digest mixture of spot 7...

Cryoglobulins analysis is an important but unfortunately a neglected test in clinical practice because of the difficulty of the test. Cryoglobulins are special type of immunoglobulins that reversibly precipitate from serum at cold temperatures [33], They can be associated with skin lesions (purpura), glomerulonephritis, and peripheral neuropathy, or malignancy [8]. These are divided into two general... 

Cryoglobulins are special immunoglobulins that reversibly precipitate from serum at cold temperatures. Cryoglobulins can be classified as monoclonal globulins (type I), mix of polyclonal-monoclonal (type II), or mix of polyclonal-polyclonal (type III) immunoglobulins. Cryoglobulins can precipitate in different tissues of the body such as the kidney and the extremities. They are associated with several immune-type disorders, viral infection, glomerulonephritis, peripheral neuropathy, and diffuse vasculitis. 

Figure 3 Type II cryoglobulin of a patient by CE top (C) is cryoprecipitate, and bottom (S) is serum (A = albumin, G = glob-obulin, M = monoclonal peak). CE conditions as in Figure 2.

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