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What are the potential causes of increased β-globulins?

BC6062 Clinical Biochemistry (2024-2025)

A 90-year-old man who had a history of transurethral prostate resection for benign prostatic hyperplasia was admitted for left hip pain. A hip radiography examination revealed a large osteolytic lesion in the left greater trochanter, and a bone scintigraphy evaluation showed creased activity in the same area. Because of the patient’s history, metastasis from prostate carcinoma was suspected, and bone biopsies were performed the same week. Ten days later, the patient was hospitalised in the emergency department after a fall that fractured the femoral neck. At admission, plasma sodium, chloride, and potassium concentrations were all within their respective reference intervals.

Table 1: Laboratory Results

Test	Result	Reference Range
Plasma concentration of total protein	50.0	60-80 g/L
Albumin	15	30-45 g/L
Corrected calcium	2.69	2.25-2.65 mmol/L
MCV	95.1	80-97 fL
Reticulocyte count	54	25-80 X 109/L
Hb	9.9	13-17 g/dL
WBCs	2.5	4.0-10.0 X 109/L
Creatinine	97	62-106 mol/L
Urea	12.5	2.8-7.0 mmol/L
Urine protein	540	0-150 mg/24 h
Free light chain	14	0.0-2.0 mg/L
Β2-microglobulin	Normal

 

 

Figure 1:   (A) UPEP on concentrated urine protein, (B) Seum electrophoresis, and (C) Serum protein immunofixation.

The patient underwent surgical repair of his left femur, and the laboratory results after that procedure are shown below.

Table 2: Laboratory Results

Test	Results	Reference Range
Albumin	14.5	30-45 g/L
IgG	29.5	7-10 g/L

 

Serum protein electrophoresis (SPEP) showed

1) an increased α1 region and decreased albumin and γ regions.

2) An increase in the β region

Figure 2: Immunofixation of Serum (S) and urine (U) proteins.

Serum immunofixation:

1) monoclonal protein concentration 16 g/L

2) decreased free k chain of 0.6 mg/L (Ref. Range 3.3-19.4 mg/L)

3) decreased free λ chain 0.45 mg/L (Ref. Range 5.7-26.3) mg/L)

4) k/λ ratio 1.33 (Ref. Range 0.26-1.65)

IgG subclass qualifications

1) IgG1 7.68 (ref Range 5-8 g/L)

2) IgG2 <9.0 (ref Range 0.9-3.0 g/L)

3) IgG3 0.23 (ref Range 0.1-0.8 g/L)

4) IgG4 0.01 (ref range 0.1-0.6 g/L)

Questions

1) What are the potential causes of increased β-globulins?

2) What can explain the discrepancy between the presence of k light chains in the urine and a monoclonal IgG without light chains in the serum?

3) What investigations should be performed to characterise the protein responsible for the spike in the β region of the urine electrophoresis results?

4) What can explain the observation that the sum of the 4 IgG subclasses <8 g/L) was not equal to the total IgG concentration of 29.5 g/L?

Example Answer - Please Do Not Copy, It`s Plagiarised

The BC6062 Clinical Biochemistry assignment focuses on exploring the biochemical foundations of clinical practice. It requires students to analyse and interpret biochemical data in relation to various diseases and disorders, highlighting the role of biochemistry in diagnosis, treatment, and monitoring. The assignment aims to develop critical thinking and problem-solving skills by integrating theoretical knowledge with practical application in clinical settings. Students will need to demonstrate their understanding of key biochemical processes, diagnostic tests, and their relevance in medical conditions. Emphasis is placed on accuracy, clarity, and evidence-based approaches to support clinical decision-making.

What are the potential causes of increased β-globulins?

Increased β-globulins can arise from several conditions, typically related to changes in the immune system, inflammation, or malignancy. Some potential causes include:

• Chronic inflammation or infection: Conditions such as chronic infections (e.g., tuberculosis, chronic bacterial infections) or inflammatory diseases (e.g., rheumatoid arthritis) can lead to an increased β-globulin fraction, as part of the acute-phase response.

• Liver disease: Hepatic cirrhosis or hepatitis can lead to an altered protein synthesis, including increased production of β-globulins as part of the liver`s response to injury.

• Multiple Myeloma or other plasma cell dyscrasias: The β region can show an increase due to the presence of monoclonal immunoglobulin, especially if there is a monoclonal gammopathy (e.g., as indicated by the monoclonal protein identified in the serum). This is consistent with a possible plasma cell disorder, such as multiple myeloma, which can cause abnormal globulin production.

• Polyclonal gammopathy: This is typically seen in conditions like autoimmune diseases (systemic lupus erythematosus, etc.), where there is widespread stimulation of immune cells, leading to an increase in the β-globulin region, often in conjunction with an increase in γ-globulins.

• Nephrotic syndrome: In cases of nephrotic syndrome, there can be altered protein levels, which may affect β-globulins as the kidneys are unable to properly filter proteins.

• Monoclonal gammopathy of undetermined significance (MGUS): This is a benign condition that may present with increased β-globulins due to the presence of monoclonal protein (as seen in the patient’s serum).