with no obvious pathology.IgE plays a major part in allergy and may be significantly
raised in situations of allergic response, for example in hay fever and atopic eczema.
Myeloma
Myeloma, also calledmultiple myeloma, is a malignant pathology of plasma cells in
which there is a proliferation of a singleb-cell clone in the bone marrow effectively
behaving as a tumour. The replication of the cell is unregulated so it proliferates. The
cells produce large quantities of a single identical antibody which runs as a single dense
band in the gamma globulin region on electrophoresis of a serum sample. The protein is
called thepara proteinand has been shown to be an immunoglobulin with two light
chains and two heavy chains. Some myelomas produce an excess of light chains that
appear in the serum and because they are small they also appear in the urine. They are
detected by electrophoresis and are referred to asBence Jones proteins.Theirdetection
is a bad prognosis as they indicate that the cell line may be more aggressive and
replicating faster. In rare cases of myeloma, the marrow cells only produce light chains.
Acute phase response
Following a stimulus of tissue injury or infection, the body will respond by producing an
acute phase responsecharacterised by the release from the liver of a number ofacute
phase proteinswhich cause a change in the pattern of plasma protein electrophoresis.
There will be an increased synthesis of some proteins such asa-1-antitrypsin, a protein-
ase inhibitor that down regulates inflammation, fibrinogen and prothroylian (coagula-
tion) complement and C-reactive protein (CRP). These are referred to aspositiveacute
phase proteins. There will also be a decrease in the production of other proteins such as
albumin, transferrin and transcortin. These are known asnegativeacute phase proteins.
The clinical measurement of acute phase proteins, particularly CRP, by immunoassay is
widely used as a marker of inflammation in a variety of clinical conditions.
16.4 Suggestions for further reading
Basic principles
Saunders, G. C. and Parkes, H. C. (1999).Analytical Molecular Biology. Teddington: LGC. (Contains
an excellent chapter on quality in the molecular biology laboratory.)
Clinical biochemistry
Beckett, G. I., Walker, S. W., Rae, P. and Ashby, P. (2005).Lecture Notes on Clinical Biochemistry,6th
edn. Oxford: Blackwell Science. (An excellent reference text for all aspects of clinical biochemistry.)
Bruns, D. E. and Ashwood, E. R. (2007).Tietz Fundementals of Clinical Chemistry, 6th edn.
Philadelphia: W. B. Saunders. (A comprehensive coverage of the principles and practice of
clinical biochemistry.)
Data analysis
Jones, R. and Payne, B. (1997).Clinical Investigation and Statistics in Laboratory Medicine.
London: ACB Ventures. (Written specifically for analytical studies in clinical biochemistry.)
Newborn screening
Blau, N., Duran, M., Blaskovics, M. E. and Gibson, K. M. (eds.) (2003).Physician’s Guide to the
Laboratory Diagnosis of Metabolic Diseases, 2nd edn. Berlin: Springer-Verlag.
658 Principles of clinical biochemistry
