Perpendicular drop includes the entire area under the M-protein gate on the electropherogram, whereas tangent skimming provides one way to exclude potential underlying polyclonal immunoglobulin
from the overall M-protein quantitation (Figure 1).
We propose that the definition of STSS extends beyond that of a condition exclusive to GAS infection and recommend that polyclonal immunoglobulin
be considered as a potentially lifesaving adjunctive therapy.
free light chains as a potential biomarker of immune stimulation and inflammation.
Meta-analyses of trials of intravenous immunoglobulin for suspected or proven neonatal sepsis suggest a reduced rate of death from any cause, but the trials have been small and have varied in quality.14 A number of studies support the administration of IVIG along with supportive and antibiotic therapy in neonatal sepsis.14-16 According to the International Guidelines for Management of Severe Sepsis and Septic Shock in 2008, there is a grade 2C recommendation for the use of polyclonal immunoglobulin
in paediatric sepsis syndrome.17 Based on these guidelines, the administration of intravenous polyclonal immunoglobulin
has been reported to reduce the mortality rate and is a promising adjuvant in the treatment of sepsis and septic shock in neonates.18
(3) The HMS is presented as an exaggerated immune response to infection by Plasmodium, resulting in nonspecific, hyper-immunoglobulin M (IgM) polyclonal immunoglobulin
production by B lymphocytes, and the formation of immune complexes that are deposited in the spleen.
(1,2,4,5,8) Samples with increased polyclonal immunoglobulin
concentrations have not been reported to exhibit interference.
Following the "total" immunoglobulin class within which the monoclonal protein falls may be misleading when there are alterations in the concentrations of polyclonal immunoglobulin
(Ig) G (1:100; KPL, Inc., Gaithersburg, MD, USA) as the primary antibody, and Alexa fluor 488-labeled rabbit antigoat IgG (1:200, Invitrogen, Carlsbad, CA, USA) as the secondary antibody.
When there is increased polyclonal immunoglobulin
production and/or renal impairment, both is and [kappa] FLC concentrations can increase 10- to 20-fold.
(1997) Neph (poly) 5.03 3.42 0.58 0.38 (a) Pure para, purified monoclonal immunoglobulin paraprotein; poly, polyclonal antisera against IgGSc; mono, monoclonal antibodies against IgGSc; SPS01, Serum Protein Standard O1; USNRP, US National Reference Preparation for specific human serum proteins; PCFI, particle concentration fluorescence immunoassay; Pure poly, purified polyclonal immunoglobulin
; Neph, nephelometry.
Algorithms function well as an initial screening of polyclonal immunoglobulin
concentrations, but they cannot differentiate between IgG and IgM.
Usually, the intense contribution from polyclonal free light chains is sufficient to enable the correct interpretation in the absence of visible [[alpha].sub.2]-microglobulins; however, in the present case this was not true because of a lack of polyclonal immunoglobulin