Immunochemistry in Clinical Laboratory Medicine

Immunochemistry in Clinical Laboratory Medicine

1m munochem istry in eli n i c a I Lab 0 rat 0 ry Medicine Edited by A. Milford Ward and J. T. Whicher Proceedings of a symposium held at the University of Lancaster, March, 1978 -~ ' -- MTPPRESS LIMITED IntenwtiOll l1 MediCilI PlIhlishers

Published by MTP Press Limited Falcon House Cable Street Lancaster, England Copyright (C) 1979 MTP Press Limited Softcover reprint of the hardcover 1 st edition 1979 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. ISBN-13: 978-94-011-6593-8 e-isbn-13: 978-94-011-6591-4 DOl: 10.1007/978-94-011-6591-4 Northgate, Blackburn, Lancs BB2 lab

Contents List of Contributors Preface ix xi SECTION ONE Methods and Problems in Immunochemistry Chairmen: Dr A. Milford Ward and Dr A. R. Bradwell 1 Electrophoresis and immunoelectrophoresis 3 Pamela G. Riches 2 Radial immunodiffusion and rocket immunoelectrophoresis 17 D. Kenny 3 Automated immunoprecipitation and laser nephelometry 23 p. A. E. White and R. Strong 4 Antiserum requirements 35 A. C. Munro 5 Problems encountered in immunochemical technique methodology 51 J. T. Whicher 6 Specific protein measurement and standardization 63 R. S. Wainwright, J. R. Doggart and D. W. Neill 7 Quality control 75 D. M. Browning

vi IMMUNOCHEMISTRY IN CLINICAL LABORATORY MEDICINE SECTION TWO Specific Proteins in Laboratory Diagnosis Chairmen: Mr D. M. Browning, Dr R. S. H. Pumphrey, Dr J. Kahn, Professor J. Hardwicke and Dr A. C. Munro 8 Structure and function of the immunoglobulins 85 R. S. H. Pumphrey 9 Immunoglobulins in blood transfusion 99 P. D. J. Holt 10 Monoclonal proteins 115 J.Kohn 11 Iron binding proteins 127 A. Jacobs 12 Albumin 135 Linda Smith 13 The complement system 149 J. T Whicher 14 Alphafetoprotein in obstetrics 165 D. J. H. Brock 15 Alphafetoprotein in oncology 177 J. Kahn 16 ai-antitrypsin 183 A. Milford Ward 17 Haptoglobin and orosomucoid in lung and breast tumours 197 A. R. Bradwell

CONTENTS vii SECTION THREE Immunochemistry of Other Body Fluids Chairman: Dr J. T. Whicher 18 Urinary proteins 219 J. Hardwicke 19 Immunochemistry of CSF proteins 229 E. J. Thompson Discussion 237 Index 243

List of Contributors Dr A. R. BRADWELL Immunodiagnostics Research Laboratory, University of Birmingham Dr D. J. H. BROCK Department of Human Genetics, University of Edinburgh Mr D. M. BROWNING Wolfson Research Laboratory, Department of Clinical Chemistry, Queen Elizabeth Medical Centre, Birmingham Mr J. R. DOGGART Department of Biochemistry, Royal Victoria Hospital, Belfast Professor J. HARDWICKE Department of Immunology, University of Birmingham Mr P. D. J. HOLT Immunochemistry Laboratory, South West Regional Transfusion Centre, Bristol Professor A. JACO BS Department of Haematology, University Hospital of Wales, Cardiff Mr D. KENNY Department of Biochemistry, Our Lady's Hospital for Sick Children, Dublin Dr J. KOHN Supraregional Protein Reference Unit, Putney General Hospital, London Dr A. C. MUNRO Glasgow and West of Scotland Blood Transfusion Service, Law Hospital, Carluke, Lanarkshire Mr D. W. NEILL Department of Biochemistry, Royal Victoria Hospital, Belfast DrR. S. H. PUMPHREY Department of Immunology, St Mary's Hospital, Manchester Dr PAMELA G. RICHES Supraregional Protein Reference Unit, Westminster Hospital Medical School, London

x IMMUNOCHEMISTRY IN CLINICAL LABORATORY MEDICINE Dr LINDA SMITH Department of Biochemistry, Hull Royal Infirmary, Hull Mr R. STRONG Supraregional Protein Reference Unit, Hallamshire Hospital, Sheffield Dr E. J. THOMPSON Department of Chemical Pathology, National Hospital for Nervous Diseases, Queen's Square, London Dr A. MILFORD WARD Supraregional Protein Reference Unit, Hallamshire Hospital, Sheffield Mr R. S. WAINWRIGHT Department of Biochemistry, Royal Victoria Hospital, Belfast Dr J. T. WHICHER Department of Chemical Pathology, Bristol Royal Infirmary, Bristol Mr P. A. E. WHITE Supraregional Protein Reference Unit, Hallamshire Hospital, Sheffield

Preface The rapid growth of specific protein estimations in the clinical laboratory over the last 10 years has been due to advances both in methodology and in the understanding of the role of the various plasma proteins in health and disease. This expansion has been made possible by the development of both gel phase and fluid phase techniques for the estimation of proteins and the ready availability of antisera to individual plasma proteins. The specificity of the immunological reaction has allowed the more precise identification and estimation of individual plasma proteins than was possible with dye binding or other chemical techniques, but at the same time these methods have introduced other possible errors and pitfalls. Advances in understanding of the structure and function of various plasma proteins has pointed the way to new clinical applications of plasma protein estimation in the diagnosis and monitoring of disease. The Symposium, of which these are the proceedings, was planned to bring together a number of experts in the field to discuss the available methods and their clinical application. The first part of the Symposium was devoted to methodology and dealt with techniques, reagent supply and control, and the various problems which might arise in the routine clinical laboratory. The second, and larger, part of the Symposium was devoted to a discussion of the clinical relevance of some of the more commonly estimated plasma proteins. The scope of the discussion was enlarged to include proteins in urine and cerebrospinal fluid. It was not the intention of the Symposium to discuss all the possible uses of immunochemistry in relation to clinical laboratory medicine but simply to highlight some of the advantages and disadvantages of immunochemical methods for the estimation of certain plasma proteins and to put these into a proper perspective in relation to modern clinical laboratory practice. The contributors and editors are deeply grateful to the Hyland Division of Travenol Laboratories Limited who sponsored the Symposium and provided the administrative services needed to run it. The editors acknowledge the helpful collaboration of our publisher, and of Mrs. Judy Fagelston who transcribed the discussions.