Plasma Protein Electrophoresis Research Articles

Male systemic lupus erythematosus, rapidly progressive glomerulonephritis, and iatrogenic acute bone marrow failure: a case report

Lupus nephritis (LN) is a significant complication of systemic lupus erythematosus (SLE), marked by kidney inflammation due to autoimmune activity, leading to proteinuria, hematuria, and potentially renal failure. Rapidly progressive glomerulonephritis (RPGN) is a rare, critical manifestation of LN characterized by a rapid decline in kidney function. This condition can lead to irreversible renal damage and is often fatal without prompt treatment. In this case, a 62-year-old man initially presented with fever, cough, and body aches, which were treated as an acute upper respiratory infection. Despite initial improvement, he developed persistent nausea, vomiting, and signs of renal dysfunction. Laboratory investigations revealed anemia, high erythrocyte sedimentation rate (ESR), electrolyte imbalances, and elevated creatinine. Imaging and endoscopy ruled out malignancy, and a differential diagnosis of multiple myeloma was excluded through plasma protein electrophoresis. Serological tests confirmed SLE, and subsequent renal biopsy revealed LN with RPGN features. Despite aggressive treatment with corticosteroids and cyclophosphamide, the patient’s condition rapidly deteriorated, leading to respiratory distress and intensive care unit (ICU) admission. He ultimately succumbed to his illness, underscoring the unpredictable and severe nature of RPGN in LN. This case highlights the importance of early diagnosis and intensive management to prevent rapid disease progression and improve patient outcomes.

Assessment of serum protein profile in sickle cell disease

Background: Sickle Cell disease (SCD) is known to be caused by a mutation in the beta-globin gene of the hemoglobin that affects the red blood cells (RBCs) and is passed down through generations. This study was carried out to determine the effect of sickling of RBC on serum protein profile in SCD individuals. Methods: A case-controlled study was carried out among 80 patients. They were forty-five sickle cell disease individuals (HbSS) attending Children Specialist Hospital Ilorin and thirty-five healthy controls (HbAA). The levels of total protein and albumin were determined spectrophotometrically and serum protein electrophoresis (SPE) was carried out using cellulose acetate electrophoresis. Results: Significant hypoalbuminemia and hypergammaglobulinemia were observed in SCD groups compared with controls. A higher proportion of the SCD group, 11(25%) had hypergammaglobulinemia and 21(49%) had hypoalbuminemia (P<0.05). Plasma protein electrophoresis in SCD patients shows an intense colour at the gamma region which was not seen in control. There was a significant relationship between the patterns of serum protein electrophoresis and the frequency of crisis. Conclusions: Sickle cell disease crisis and other associated underlying conditions may be prevented early through assessment of serum protein profile, especially SPE. Hypergammaglobulinemia and hypoalbuminemia may be associated with frequent episode of crisis.

Cardiac Amyloidosis Masquerading as Hypertrophic Obstructive Cardiomyopathy: Co-existence or Coincidence?

Abstract A 59-year-old male presented with syncope and nonsustained ventricular tachycardia and was diagnosed to have hypertrophic obstructive cardiomyopathy. He underwent dual-chamber implantable converter defibrillator (ICD) insertion. Following ICD insertion, in view of some red flags, routine cardiac magnetic resonance imaging was performed, which showed biventricular hypertrophy, diffuse subendocardial gadolinium enhancement of both the ventricles, prolonged T1 and T2, and left ventricular extracellular volume fraction of 50%. A pyrophosphate scan of the heart was strongly positive both at 1 and 3 h intervals. M-band was observed on plasma protein electrophoresis. Serum and urinary immunofixation studies suggested lambda light-chain gammopathy. Multiparametric flow cytometry of the bone marrow aspirate revealed 20% plasma cells immunophenotyped to produce only light-chain immunoglobulins. The patient is on specific chemotherapy for the past 7 months and is asymptomatic.

PLASMA PROTEIN ELECTROPHORESIS IN THE WHITE STORK (CICONIA CICONIA): AGREEMENT BETWEEN AGAROSE GEL VERSUS CAPILLARY ZONE METHODS AND DEVELOPMENT OF REFERENCE INTERVALS.

The white stork (Ciconia ciconia) is a ciconiiform species widely represented in zoological institutions. Plasma protein electrophoresis is widely used in avian patients for assessment of inflammatory conditions, but reference intervals for this testing modality are lacking for the white stork. The two main electrophoretic methods are agarose gel electrophoresis (AGE) and capillary zone electrophoresis (CZE). This study assessed fresh plasma samples of healthy adult white storks (n = 30). Statistical analyses were performed to evaluate agreement between AGE and CZE. Typical electrophoretic fractions were obtained from both methods (prealbumin, albumin, α1, α2, β, γ1, and γ2). The AGE and CZE methods were not equivalent for determining major electrophoretic fractions (except β-globulins) and albumin:globulin ratio on plasma samples. An additional prealbumin fraction was seen with CZE. Reference intervals were established for each method as the smallest n group was 27 individuals for a given value; most values had normal distribution, and robust or parametric methods were used on the data.

Bilateral Extensive Serous Retinal Detachment in a Patient with Multiple Myeloma

Purpose: To describe a case of bilateral serous retinal detachment in a patient with multiple myeloma.Case summary: A 75-year-old woman presented with sudden-onset of reduced visual acuity in both eyes which had begun 2 days prior. Initial ophthalmological assessment revealed that visual acuities were 0.03 in the right eye and 0.05 in the left eye. Optical coherence tomography indicated pronounced macular elevation and extensive subretinal fluid accumulation in the posterior pole of both eyes. Fluorescein angiography did not detect any significant vascular leakage. Blood tests showed an albumin level of 2.1 g/dL, and plasma protein electrophoresis revealed an M protein level of 0.19 g/dL. Multiple myeloma-related hypoalbuminemia and paraprotein were suspected. The patient's retinal statuses were closely monitored and compared with blood test outcomes. Over 2 months, there was significant improvement, characterized by decreasing macular elevation and reduction of subretinal fluid. This progress was sustained thereafter. Plasma protein electrophoresis showed a gradual decline in paraproteins which coincided with the amelioration of serous retinal detachment.Conclusions: We encountered a case of acute and extensive serous retinal detachment in both eyes of a patient with multiple myeloma. When fluorescein angiography does not definitively show vascular leakage, light chain deposition disease-related serous retinal detachment should be considered. In such instances, it is important to address and monitor the underlying multiple myeloma.

Blood collection under anesthesia, peripheral blood cells, plasma biochemistry, and plasma protein electrophoresis in a living fossil: the Spotted Ratfish (Hydrolagus colliei).

This report describes the safe and effective handling under anesthesia, blood collection and main clinical pathology values determination for three adult Spotted Ratfish (Hydrolagus colliei) (two males and one female) successfully maintained under human care for more than 20 years. The anesthetic MS-222 diluted in tamponed salt water at 50 ppm provided deep narcosis with mean induction and recovery times of 5 and 20 min, allowing safe handling and blood collection in the three animals sampled. Major leukocyte types were similar to other teleost and elasmobranch species, identifying lymphocytes as the predominant leukocyte (75.5%), followed by the fine eosinophilic granulocytes (10.25%), the coarse eosinophilic granulocytes (9.75%), and a small percentage of monocytes (5.50%). Plasma biochemistry values in this species were like those seen in elasmobranchs, with the highest levels of blood urea nitrogen described in any Chondrichthyes (mean 679.7 mmol/l). Plasma protein electrophoresis analysis in the Spotted Ratfish showed five consistent fractions, like those previously described in other fish species, with a negligible quantity of proteins migrating in the region equivalent to albumin, and with fraction 4 (mean 53.20%) as the predominant fraction. Despite the limitations imposed by the small sample size and the challenging access to the studied species under human care, this study will shed light on and enhance clinical knowledge regarding Ratfish handling, anesthesia, blood collection, and analysis. It aims to deliver a comprehensive clinical pathology description, presenting valuable data for professionals engaged in the care and management of Chimaerans.

Hematological changes in Florida pompano (Trachinotus carolinus) supplemented with β-glucan and Pediococcus acidilactici synbiotic.

Florida pompano (Trachinotus carolinus) are a species of growing interest for commercial aquaculture. Effective health monitoring is crucial to the successful growout of the species, and prophylactic and therapeutic use of chemicals and antibiotics has been the traditional strategy for promoting stock health. However, concerns about antimicrobial resistance, chemical residues in seafood products and the environment, and resultant immunosuppression have prompted the industry to identify alternative management strategies, including supplementation with prebiotics, probiotics, and combinations of both (synbiotics). The objectives of this study are to determine and compare hematological, plasma biochemical, and plasma protein electrophoresis data of synbiotic-supplemented (β-glucan and Pediococcus acidilactici) and non-supplemented Florida pompano. Reference intervals for blood analytes are provided for both groups and for subgroups (females, males, large, and small fish) where statistically significant results exist. There are no differences between the hematological and plasma biochemistry analytes between the supplemented and control groups, except for blood urea nitrogen and carbon dioxide, indicating a possible effect of synbiotic supplementation on gill function and osmoregulation. Sex-related and size-related differences are observed within each of the control and supplemented groups; however, biometric measurements do not strongly correlate with blood analytes. These data represent baseline hematological and plasma biochemical data in the Florida pompano and indicate the safety of synbiotic supplementation in this commercially important species. This study serves to further the commercialization of Florida pompano by providing blood analyte reference intervals for health monitoring in the aquaculture setting.

A Pilot Study Investigating Plasma Protein Electrophoresis in One Anuran and Six Urodelan Species.

As threats to amphibian health increase, there is a growing need for diagnostic tools to assess and monitor their health status. Plasma protein electrophoresis has proven to be useful in other nonmammalian species. It enables quantification of protein fractions in plasma that may be altered in various disease processes, and is therefore useful in narrowing down differential diagnoses and detecting inflammation, in combination with other modalities such as biochemical and hematologic testing. The amphibian electrophoretogram must be defined before baseline reference intervals are obtained across species. Agarose gel electrophoresis was performed on plasma samples collected from presumed clinically normal individuals of one anuran and six urodelans: Osteopilus septentrionalis (n=2), Gyrinophilus porphyriticus (n=1), Notophthalmus viridescens (n=1), Eurycea guttolineata (n=2), Amphiuma tridactylum (n=2), Cryptobranchus alleganiensis (n=5), and Siren lacertina (n=6). The electrophoretograms varied in number of fractions between each species; however, the number of fractions was consistent within a species. An albumin migrating fraction was consistently observed in all species. A prealbumin migrating fraction was identified in species that primarily use organs other than skin for respiration. This study provides preliminary examples of a normal plasma protein electrophoretogram for seven amphibian species. Further studies quantifying reference intervals and identification of protein fractions will help establish protein electrophoresis as a useful tool in amphibian health investigations.

DP25 Widespread subcutaneous nodular kappa light chain amyloidosis

Abstract A 69-year-old woman was referred to the dermatology department for evaluation of multiple widespread subcutaneous lesions involving the neck, torso and limbs. These lesions, initially diagnosed in the community as lipomas, had been slowly progressing in size and number for 3 years. She had remained systemically well. Her only medical history was essential thrombocythaemia. She took no regular medication. On examination, there were multiple subcutaneous lesions appreciated on palpation with no overlying epidermal change. The patient was experiencing pain in a sciatic distribution. Magnetic resonance imaging of the femur showed a 12-cm enhancing area of subcutaneous nodularity encasing the sciatic nerve. Computed tomography of the chest, abdomen and pelvis showed multiple subcutaneous, ill-defined, soft tissue lesions of the anterior abdominal wall with no lymphadenopathy or organ abnormality. Deep incisional biopsies from two separate locations were completed. There was an unremarkable epidermis and dermis. In the subcutaneous fat, the septae appeared thickened alongside thickened elastic fibres and a prominent multifocal granulomatous reaction with a high degree of elastophagocytosis. There were multifocal aggregates of plasma cells that displayed no cytological atypia. In situ hybridization showed strong kappa light chain restriction. Plasma protein electrophoresis was completed and confirmed a paraprotein band in the gamma region of IgM kappa. Full blood count revealed a high platelet count (585 × 109 cells L–1) but was otherwise unremarkable alongside normal renal and liver function, bone profile, lactate dehydrogenase, B2 microglobulin, Bence–Jones proteins and infection screen. A Congo red stain was performed on the original histological samples. This showed apple green birefringence under polarized light-confirming amyloid. Haematology completed a bone marrow biopsy, which was normal. Referral to the National Amyloid Centre was made. Serum amyloid P scan showed no visceral involvement. A diagnosis of subcutaneous amyloid kappa light chain subtype (AL) was made. The patient has since commenced rituximab, bortezomib (Velcade®), cyclophosphamide and dexamethasone (R-VCD) chemotherapy at 4-weekly intervals over a 4-month period. Primary localized cutaneous amyloidosis is characterized by extracellular deposition of amyloid protein in the skin without evidence of systemic involvement and is often subtyped into macular, papular and nodular. Amyloidoma (tumoral amyloidosis) is rare and defined as a solitary localized deposit of amyloid. There are only four case reports in the literature of multiple subcutaneous amyloid deposits, and only one of these cases was of AL (light chain) vs. amyloid A (AA) subtype. This case showed nodules restricted to the neck (Nguyen TU, Oghalai JS, McGregor DK et al. Subcutaneous nodular amyloidosis: a case report and review of the literature. Hum Pathol 2001; 32:346–8). To our knowledge, this is the first case of widespread kappa light chain subcutaneous amyloidosis.

HEALTH ASSESSMENT OF PAINTED TURTLES (CHRYSEMYS PICTA) IN A RESTORED WETLAND HABITAT IN NORTHWESTERN INDIANA, USA.

Freshwater turtles are sensitive to environmental changes and can serve as sentinel species for ecosystem health assessments. The Efroymson Restoration at Kankakee Sands in northwestern Indiana, USA has been restored in the past 25 yr from primarily agricultural land to a mosaic of prairie and wetland habitats. Health assessments of 40 free-ranging painted turtles (Chrysemys picta) at Kankakee Sands were performed in May 2021 to evaluate overall health status, screen for infectious diseases, and obtain baseline clinical pathology values in this population. Assessment of each turtle included a physical examination, complete blood count, plasma biochemistry panel, blood lactate level, venous blood gas analysis, serum trace mineral panel, serum vitamin D3 level, and plasma protein electrophoresis. Oral and cloacal swabs were tested for adenoviruses, herpesviruses, frog virus 3, and Mycoplasmopsis species by PCR in 39 painted turtles. Four turtles were positive for adenovirus, which shared 100% homology to Sulawesi tortoise adenovirus. Two turtles were herpesvirus-positive with 100% homology to emydid herpesvirus 1. No Mycoplasmopsis spp. or frog virus 3 was detected. Female turtles had significantly higher manganese, prealbumin, uric acid, triglycerides, and ionized calcium levels, while male turtles had significantly higher cholesterol, glutamate dehydrogenase, and CO2 levels. These baseline data can be used for future research into freshwater turtle health in restored wetland habitats.

Multiple Myeloma with Aberrant CD3 Expression in a Red-Lored Amazon Parrot (Amazona autumnalis).

A 20-year-old, female, red-lored Amazon parrot (Amazona autumnalis) was presented for a 2-week history of weakness. On physical examination, the bird was quiet, fluffed, weak, and had a distended coelom. Radiographic and ultrasound imaging revealed coelomic distention, increased pulmonary parenchymal opacity, renomegaly, dilated intestines, and a thickened ventricular wall. The results of a complete blood cell count indicated the patient was anemic (28%) and had intermediate to large lymphocytes with immature chromatin that were suspected to be neoplastic. Immunocytochemistry on peripheral blood determined that the suspected circulating neoplastic cells were cluster of differentiation (CD) 3+ and occasionally expressed multiple myeloma oncogene 1 (MUM1). Abnormalities from a plasma biochemistry panel were moderate hyperphosphatemia (6.8 mg/dL), marked hyperproteinemia (13.6 g/L), analbuminemia (0 g/dL), and marked hyperglobulinemia (13.6 g/dL). Agarose gel plasma protein electrophoresis documented the presence of albumin (1.2 g/dL) and monoclonal bands which, on reduced lithium dodecyl sulfate polyacrylamide gel electrophoresis, resolved as 60-kd and ∼25-kd bands consistent with immunoglobulin Y heavy and light chains. On the basis of these findings, multiple myeloma was diagnosed. Because of a poor prognosis, the bird was euthanized for postmortem examination. Bone marrow cytology from samples collected during the postmortem examination revealed 17.4% plasma cells and 24% large immature cells with occasional plasmacytoid features. Histopathologic findings included aggregates of neoplastic plasma cells in the bone marrow, spleen, kidney, liver, gastrointestinal tract, muscle, ovary, and brain. The neoplastic cells were strongly immunoreactive for MUM1 and cluster of differentiation 3 (CD3), but negative for CD79a, paired box protein 5, and CD20. This confirmed the clinical diagnosis of multiple myeloma. This report describes an avian immunoglobulin Y-secreting multiple myeloma with aberrant CD3 expression and pseudoanalbuminemia. Aberrant CD3 expression by avian multiple myeloma may explain previously published cases of birds with a monoclonal gammopathy and apparent T-cell lymphoma diagnosed by CD3 immunoreactivity.

Increasing the data on elasmobranch plasma protein electrophoresis: electrophoretogram reference values determination in the undulate skate (Raja Undulata) and the nursehound shark (Scyliorhinus stellaris) maintained under human care

BackgroundThis study determined plasma protein electrophoresis (PPE) reference intervals in two elasmobranch species: the undulate skate (Raja undulata) and the nursehound shark (Scyliorhinus stellaris), using a reference population of 48 undulate skates (27 males, 21 females) and 62 nursehounds (32 males, 30 females), considered to be clinically healthy. Plasma samples were analyzed using capillary zone electrophoresis (CZE).ResultsThe undulate skate electrophoretogram resembled those previously reported in other batoids and could be divided into seven consistent fractions. No statistically significant differences were detected between sexes and developmental stages. The nursehound electrophoretogram was similar to that previously described in other shark species and could be divided into eight consistent fractions. Fraction 5% was significantly higher in juvenile nursehounds when compared to adults, while fraction 6 concentration and percentage were significantly higher in adults. Fraction 4% was higher in males than in females. Albumin band was not detected, and pre-albumin was negligible in both studied species. Alpha-globulins were predominant in the undulate skate, while beta-globulins were predominant in nursehounds. Statistically significant differences were found in all electrophoretogram fraction percentages and concentrations between the two species.ConclusionTo the authors knowledge, this is the first study reporting PPE values in undulate skates and nursehounds, and the first study using CZE in elasmobranch plasma. These findings can serve as a primary reference for health monitoring in both species and will add to the limited data available on PPE in elasmobranchs.

Detection and Characterization of Paraproteinemia in Canine Chronic B-cell Lymphocytic Leukemia Using Routine and Free Light Chain Immunofixation.

Hyperglobulinemia is reported in 26% of canine chronic B-cell lymphocytic leukemia (B-CLL) cases. However, few cases have been characterized by protein electrophoresis and immunofixation (IF), and the incidence of a monoclonal protein (M-protein) is unknown using these techniques. To characterize and determine the proportion of canine B-CLL cases with an M-protein using plasma protein electrophoresis (PPE), routine and free light chain (fLC) IF, and to assess if productive B-CLL cases express MUM1/IRF4 by cell tube block (CTB). PPE, routine (targeting IgG, IgA, IgM, IgG4, and light chain) and fLC IF were performed using 48 dog B-CLL plasma samples from patients diagnosed via peripheral blood flow cytometry. CTB was performed on a separate cohort of 15 patients. Hyperproteinemia (>7.5g/dL) was present in 17/48 cases (35%). An M-protein was detected in 32/48 cases (67%). Of these, 19/32 cases (59%) had only complete (monoclonal heavy and light chain) M-proteins detected, 10/32 cases (31%) had both complete and fLC M-proteins detected, and 3/32 cases (9%) had only an fLC M-protein detected. IgM was the most common clonal immunoglobulin isotype detected (23 cases). CD21+ cell counts were higher in cases with detectable M-protein. Plasma fLC IF suggested β-γ region interference, likely caused by clotting proteins. All B-CLL cases consistently expressed PAX5 and did not express MUM1/IRF4. Most B-CLL cases had an M-protein and were not hyperproteinemic. Most cases with paraproteins had a complete IgM monoclonal gammopathy; a subset had documented fLCs. The prognostic significance of heavy and fLC presence should be evaluated.

Establishment of reference intervals for plasma protein electrophoresis and comparison of biochemical and protein electrophoresis evaluation of albumin in central bearded dragons (Pogona vitticeps).

The aim of this study is to develop a reference interval for plasma protein electrophoresis for wild free-roaming central bearded dragons (Pogona vitticeps). This will assist the veterinarian in diagnosing and monitoring diseases in wild and captive animals. The study group consisted of 29 wild central bearded dragons of which 22 were males and 7 were females. The plasma samples were obtained from animals in a previous study and were stored frozen at -20°C for 2-3 years before analysis. Plasma protein electrophoresis was performed on 100 uL of plasma. The data were evaluated for the difference between reproductively active females and pooled males with non-reproductively active females as well as the difference between biochemical and protein electrophoresis albumin. Biochemical albumin was found to be significantly higher than electrophoresis albumin in all animals, with a mild proportional bias present. Plasma protein electrophoresis identified albumin, α - 1 and 2, β - 1 and 2 and γ fractions. The reproductively active females in this study exhibited results that were distinct from pooled males and non-reproductively active females. This study provides a reference interval for plasma protein electrophoresis in central bearded dragons that can be used as a tool for health and disease monitoring and diagnosis. The importance of the use of method and sex/season appropriate reference intervals in reptile medicine is confirmed in this study.

The discovery of multiple myeloma during the evolution of lupus nephropathy: A case report and literature review

Introduction: Systemic lupus erythematosus (SLE) has been proven to be independently associated with higher proportions of malignancies, particularly hematological patterns. We report a patient who developed multiple myeloma on underlying lupus nephropathy with poor outcome. Observation: It was a 48-year-old male patient followed in pneumology for bronchial dilatation secondary to pulmonary tuberculosis who consulted nephrology for an impure nephrotic syndrome without extra-renal signs and a renal biopsy outlining advanced endo and extra-capillary glomerulonephritis with 38% activity. The etiological investigation had revealed lupus. Despite 2 therapeutic protocols based on MMF + corticoids then cyclophosphamide + corticoids, there was no remission. He underwent conservative treatment for chronic kidney disease with stable renal function including a GFR of 27 ml/min/1.73m2. Two years after the discovery of lupus disease, the patient presented with a bleeding syndrome with a blood count showing normocytic normochromic anaemia at 4.1 g/dl, leukopenia at 830/mm3 and thrombocytopenia at 49000/mm3. The bone marrow count performed on the basis of this pancytopenia showed a plasmocytosis in 38% with a dysmorphic erythroblastic lineage (basophilic punctation and laminated cytoplasm), an absent megakaryocytic lineage and the presence of numerous naked plasma cells and dysmorphic plasma cells, numerous hemophagocytic macrophages and siderophages. Plasma protein electrophoresis did not show a monoclonal peak. The outcome was poor. Death occurred 3 days after his hospitalization in a medullary insufficiency course. Conclusion: Lupus can be the starting point for the development of a hematological malignancy at a later stage. On the other hand, cancer can induce spontaneous autoimmune manifestations or secondary to anti-tumor therapies. In our case it was a patient who developed myeloma 2 years after the onset of lupus with a poor outcome leading to death.

HEALTH ASSESSMENT OF GUANAY CORMORANT (PHALACROCORAX BOUGAINVILLII) AND PERUVIAN PELICAN (PELECANUS THAGUS) POPULATIONS AT PUNTA SAN JUAN, PERU

The Punta San Juan Marine Protected Area (PSJ) (15°22′S, 75°12′W) protects key breeding populations of Peruvian pelicans (Pelecanus thagus) and guanay cormorants (Phalacrocorax bougainvillii) within the Humboldt Current Large Marine Ecosystem (HCLME). This project's aim was to define current population health and provide an important baseline for continued temporal monitoring. Samples from 110 cormorants and 45 pelicans were collected for complete blood cell counts, plasma biochemistries, plasma protein electrophoresis, and diagnostic testing for avian pathogens (paramyxovirus types 1, 2 and 3; adenovirus types 1 and 2; reovirus; equine encephalitides [Eastern, Western, Venezuelan]; West Nile virus; avian influenza; infectious bursal disease; Marek disease; encephalomyelitis virus; Mycoplasma gallisepticum; Salmonella pullorum; Chlamydia; and Aspergillus). Results of this health assessment demonstrated a low exposure to common avian pathogens. Evidence of exposure to paramyxoviruses, adenoviruses, and Venezuelan equine encephalitis virus was identified most frequently. Although overall prevalence was low, the detection of these viruses highlights potential susceptibility risks for disease outbreaks in this relatively naïve population that can help guide conservation efforts. Continued monitoring of avifauna health at PSJ is a vital component of protection of the unique HCLME.

COMPARISON OF SUBCARAPACIAL SINUS AND BRACHIAL VEIN PHLEBOTOMY SITES FOR BLOOD COLLECTION IN FREE-RANGING GOPHER TORTOISES (GOPHERUS POLYPHEMUS).

Paired blood samples were collected from the brachial vein and subcarapacial sinus of 42 wild gopher tortoises (Gopherus polyphemus) for comparison of hematological and plasma biochemical, vitamin, mineral, and protein electrophoresis parameters with general linear models with repeated measures designs. Comparisons revealed higher brachial vein mean values for 38 of 42 parameters with significance (P ≤ 0.05) for 21 parameters. Significantly lower brachial vein means were noted for two parameters. Coefficients of variation for brachial vein samples were lower for 30 out of 42 parameters with significantly lower values for 11 parameters. Of the 12 parameters with lower coefficients of variation for subcarapacial sinus samples, significant differences were noted for four parameters. Both the lower coefficient of variation and the higher mean values for most parameters from brachial vein samples are attributed to greater hemodilution of subcarpacial samples with lymph compared to the paired brachial vein samples. To address the clinical relevance and reliability of the parameter ranges obtained from both paired phlebotomy sites, we compared these values to those obtained from other selected investigations of gopher tortoise and desert tortoise (Gopherus agassizii) clinicopathology. Although statistically significant differences were detected, available data demonstrated that most mean ± standard deviation values and/or ranges for both phlebotomy sites of our study are similar to those reported for the selected studies. Based on these results, utilization of either set of our study values in the assessment of a gopher tortoise population or individual gopher tortoises would be acceptable for clinical or management decisions. It is also advisable that investigators develop institutional blood parameter ranges for healthy individuals by phlebotomy site when possible in addition to maintaining standardized sample collection and handling protocols.

Comprehensive health assessment and blood analyte reference intervals of gopher tortoises (Gopherus polyphemus) in southeastern FL, USA.

The gopher tortoise (Gopherus polyphemus), a keystone species, is declining throughout its geographic range. Lack of knowledge with respect to the potential infectious diseases present within wild populations creates a dilemma for wildlife biologists, conservationists and public policy makers. The objective of this study was to conduct a health assessment of two previously unstudied gopher tortoise aggregations located at two sites in southeastern FL. Samples were collected from 91 tortoises (48 adults, 35 juveniles, 8 hatchlings) captured at Florida Atlantic University's Harbor Branch Oceanographic Institute, in Fort Pierce, FL, USA in 2019, and Loggerhead Park in Juno Beach, FL, USA, during 2018-2019. Samples of blood, nasal swabs and oral/cloacal swabs were analyzed for hematology, plasma protein electrophoretic profiles and infectious disease testing including Mycoplasma spp. serology and polymerase chain reaction (PCR) assays for Ranavirus, Herpesvirus and Anaplasma spp. Hematological and plasma protein electrophoresis reference intervals are presented for adult and juvenile tortoises from both sites combined. Clinical signs consistent with upper respiratory tract disease (URTD) were observed in 18/91 (20%) tortoises, and antibodies to Mycoplasma agassizii were detected in 33/77 (42.9%) tortoises. Adult tortoises were significantly more likely than juveniles to have URTD clinical signs, and statistically significant, positive relationships were observed between the presence of antibodies to Mycoplasma spp. and carapace length, packed cell volume and plasma globulin concentrations. Anaplasma spp. inclusions were observed in 8/82 (10%) tortoises, but PCR detected Anaplasma sp. in 21/83 (25%) tortoises. Herpesvirus and Ranavirus were not detected in any blood or swab samples. This work contributes important baseline information on the health of gopher tortoises toward the southern end of the species' range.

SUN-390 MIXED AMYLOSE AA AND AL

Systemic amyloidosis is a rare disease that can affect multiple organs. Renal involvement is the most common and the most clinically expressive. Its diagnosis is histological based on the presence of amyloid deposits which are most often either type AA essentially complicating infections and chronic inflammatory rheumatism, either of primitive AL type or during dysglobulinemia. This presentaion is about the first case in ou the first case of mixed amyloidosi AL and AA. Descriptive presentation of the first mixed amylosis AA and AL that occured in the nephrology departement of Sahloul hospital in 2019. The case of a 66-year-old man with a history of treated and cured tuberculosis, gout and benign prostatic hypertrophy who was admitted to primary renal insufficiency with a creatinine count of 1078 was presented. Examination the patient had a small tension and clinical splenomegaly. In biology were found bi cytopenia with normochromic normocytic anemia, leukopenia and nephrotic syndrome. Plasma protein electrophoresis was performed and showed hypogammaglobulinemia at 4.9 with a monoclonal peak estimated at 2.1 g / l of gamma globulins, complement by imminotyping was in favor of an IgG Lamda type monoclonal peak. Sternal puncture was performed and the diagnosis of myeloma was eliminated with a plasma cell count estimated at 6% and negative CRAB criteria. To confirm the diagnosis of amyloidosis, in front of the appearance of small kidneys, the only recourse was to perform a biopsy of accessory salivary glands which had confirmed the diagnosis of amyloidosis with histochemistry SAA (+) Kappa (-) Lamda (+). Series of complementary tests whose tumor markers were measured and showed only an increased ACE level. However, upper digestive fibroscopy and colonoscopy were normal. The patient was treated with dialysis at a rate of two sessions per week. The course was marked by a general condition preserved with onset during hospitalization of a periorbital bruise. In view of the imminilogical clinical arguments and the etiological investigation the diagnosis retained was mixed amyloidosis as a new entity and the end stage renal failure patient was adressed to hematology to manage his gammopathy. AA amyloidosis is deposited during tuberculosis, a major cause in developing countries. In our case and after eliminating a secondary cause, that was the probable cause of this AA amyloidosis. However, the clinical and biological examination did not show any activity of this tuberculosis. The patient had also a monoclonal peak of IgG lamda type with a 6% plasma cells level at the sternal puncture. This suggests the presence of a monoclonal gammopathy at the origin of AL amyloidosis especially with the appearance on clinical examination of peri-orbital eccymosis. The diagnosis of the probability of AL amyloidosis is sometimes focused on a set of arguments: clinical context compatible with AL amyloidosis, presence of serum / urinary monoclonal gammopathy or a clonal medullary plasma cell population with light chain assay. We suggest, after all these arguments the presence in this patient the first case of a mixed amyloidosis AA and AL. The techniques for identifying the nature of amyloid deposits by proteomics, currently under development, should allow in the future to identify precisely the type of amyloidosis in the majority of cases.

A Case of Multiple Myeloma Revealed by a Acute Otitis Media in Adults

Multiple myeloma or Kahler's disease is a malignant hemopathy characterized by a clonal proliferation of tumor plasma cells that invade the hematopoietic bone marrow. It is often discovered preferentially during spine, pelvis and ribs pain. Kahler's disease are rarely discovered during ENT infections. We report a case of a 58-year-old female patient that we exanimated in our ENT service for acute suppurative otitis media. The remainder of the examination revealed a swelling in the breast and functional impairment of the right upper limb. The maxillofacial CT- scan revealed lytic lacunar images of maxilla and cranial vault. Conventional X-ray displayed a fracture of the right humeral shaft. The positive diagnosis of multiple myeloma was made using bone marrow biopsy that has shown the presence of pathological plasmatic cells proliferation. Furthermore examination such as the plasma protein electrophoresis found hypo-gamma-globulinemia. Analysis of urinary sediment found κ -like Bence-Jones proteinuria. We provided Biphosphonates and analgesics treatment in addition to that of acute otitis media. Unfortunately, the death occurred six months later before he was able to benefit from a more invasive treatment protocol. This observation shows us that acute otitis media should not be trivialized, as it required a rigorous clinical examination and may surprise us.