Gamma heavy chain disease in a patient with rheumatoid arthritis – a laboratory evaluation

Introduction:

Heavy chain diseases (HCD) are neoplastic proliferations of B cells which secrete truncated immunoglobulin heavy chains without associated light chains. Being rare and probably underdiagnosed diseases the aim of this report is to show an additional case of gamma heavy chain disease in a 48 year old female patient with rheumatoid arthritis focusing on the laboratory presentation.

Materials and methods:

Laboratory work-up included agarose gel electrophoresis (AGE), capillary zone electrophoresis (CZE), immunofixation and nephelometrically determined immunoglobulin and immunoglobulin subclasses of the patient’s serum. Urine samples were also subjected to immunofixation and to a SDS-PAGE with consecutive immunoblot.

Results:

Nephelometrically measured elevated IgG concentrations were noted in combination with a decreased gamma globulin region and an increased beta globulin region on AGE. A definite monoclonal spike was not identified on AGE but at least suspected on CZE; finally serum and urine immunofixation demonstrated a monoclonal gamma heavy chain devoid of any corresponding light chains confirming the diagnosis of HCD. Analysis of the gamma heavy chain (HC) with means of SDS-PAGE revealed proteins of 40 kD and 80 kD most likely presenting a truncated HC in its monomeric and dimeric form and possibly leading to the failure of IgG-subclass typing with the applied IgG subclass antisera.

Conclusion:

This case report illustrates a new case of gamma HCD demonstrating variable laboratory manifestations and therefore the need for heightened awareness concerning this disease when confronted with abnormal and discrepant protein profiles in routinely applied laboratory tests.     

Disclosure to Parents About Everyday Activities Among American Adolescents From Mexican, Chinese, and European Backgrounds

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Departmental Climate and Student Experiences in Graduate Geography Programs

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Establishing professional relationships in practicum settings

The relationship between an associate teacher and student teacher is a crucial aspect of the practicum experience in pre-service teacher education.     

Responsible intra-action in a science center

Cultural Studies of Science Education - In this forum article, I reflect on the findings by Eva Silfver in Gender performance in an out of school science context. Silfver has studied a class of...     

How are UK Academics Engaging the Public with their Research? A Cross‐Disciplinary Perspective

This paper takes a cross‐disciplinary perspective in examining the views and practices of public engagement with research by UK academics. Using a mixed method approach consisting of a survey questionnaire and interviews, the paper identifies the range of audience groups that can potentially be engaged with by academics, and shows that some audiences are more relevant to particular disciplinary groups than others. The paper also identifies the various public engagement activities undertaken by academics and finds that some academics are using creative ways of engaging the public, such as using the services of public relations firms to help in disseminating their research in traditional media outlets, and also by using social media. Essentially, the study reveals that some academics feel the pressure of engaging particular audiences at the expense of those that are relevant to them and that, academics in the main, are opposed to the notion of mandating public engagement as part of appraisal systems.     

From Out-of-Body Experience to Embodied Imagination: How a Seriously Awkward Kid Became a Passionate if Improbable Ambassador of Yoga-Based Creativity Training for Actors,Artists … and Little Girls

A narrative reflection on the relationship between physical life and creativity, and exploration of yoga as a foundational tool for imaginative empowerment.