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      Pseudohyperphosphatemia in a Patient with Multiple Myeloma

      case-report

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          Abstract

          Hyperphosphatemia is an unusual manifestation in patients with multiple myeloma without a significantly reduced glomerular filtration rate. Serum phosphate may be falsely elevated when a large amount of paraproteins is present in the serum, because ultraviolet light absorbance is elevated with the phosphomolybdate ultraviolet assay, which is most commonly used for serum phosphate measurement. This pseudohyperphosphatemia can be confirmed by deproteinization of the serum of patients. We report a case of multiple myeloma presenting with spurious hyperphosphatemia revealing pseudohyperphosphatemia by deproteinization of serum using sulfosalicylic acid.

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          Spuriously elevated inorganic phosphate level in a multiple myeloma patient.

          B Barutcuoglu, Z Parildar, I Mutaf … (2003)
          We report the case of a patient with IgG multiple myeloma and pseudohyperphosphatemia. The patient had no clinical features of hyperphosphatemia. Subsequent investigations demonstrated that this hyperphosphatemia was spurious and was caused by a high concentration of the paraprotein. Deproteinization of the serum samples by sulfosalicylic acid resulted in normalization of the elevated phosphate values. This pseudohyperphosphatemia resulted from an increase in optic density because of interference between monoclonal immunoglobulin and the molybdic reagent used to determine phosphate in serum. These data indicate that the finding of marked hyperphosphatemia in multiple myeloma patients should always prompt an assay carried out on a deproteinized sample. In addition, knowledge of this phenomenon may avoid confusion, unnecessary testing and obviate confusion in the clinical evaluation of patients with multiple myeloma.
          Article 0 comments Cited 7 times – based on 0 reviews     Review now
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            Paraprotein interference with colorimetry of phosphate in serum of some patients with multiple myeloma.

            M Sonnenblick, U Eylath, R Brisk … (1986)
            In untreated serum of three patients with multiple myeloma, concentrations of inorganic phosphate ranged from 130 to 270 mg/L as measured with a chromogenic assay based on the interaction of phosphate ion with ammonium molybdate in the presence of ferrous sulfate. There were no clinical features of hyperphosphatemia, and values for total calcium concentration in serum remained within normal limits throughout. Subsequent investigations demonstrated that this hyperphosphatemia was spurious and was caused by high concentrations of the paraprotein interfering with the chromogenic assay. Because this type of assay, adapted for automated systems, is now widely used in clinical laboratories, we call attention to this limitation to avoid confusion in clinical evaluations of patients with multiple myeloma.
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              Immunoturbidimetry of albumin and immunoglobulin G in urine.

              A Teppo (1982)
              I describe a rapid, sensitive immunoturbidimetric assay for measuring urinary albumin and immunoglobulin G with use of an automated spectrophotometer. Diluted urine samples and polyethylene glycol in phosphate-buffered saline are pipetted into the cuvettes of the spectrophotometer. The initial absorbances of the samples are measured at 340 nm; antiserum to albumin or to immunoglobulin G is added to each tube, and after 2 min at 37 degrees C the absorbance of the mixtures is read at 340 nm. The initial blank absorbances of the samples are subtracted from the final absorbances automatically. The change in absorbance is linear with concentration in the range of 5-400 mg/L for albumin and 3-1000 mg/L for IgG. The lower limit of the determination is 5 mg/L for albumin, 3 mg/L for IgG. Linear correlations were observed between the concentrations of albumin and immunoglobulin G determined by this method (x) and those determined by radial immunodiffusion (y). The regression equation for albumin was y = 0.84x + 0.03 (r = 0.99, n = 87), and for IgG y = 0.94x + 0.02 (r = 0.98, n = 87).
              Article 0 comments Cited 4 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Electrolyte Blood Press
                Journal ID (iso-abbrev): Electrolyte Blood Press
                Journal ID (publisher-id): EBP
                Title: Electrolytes & Blood Pressure : E & BP
                Publisher: The Korean Society of Electrolyte and Blood Pressure Research
                ISSN (Print): 1738-5997
                ISSN (Electronic): 2092-9935
                Publication date (Print): December 2007
                Publication date (Electronic): 31 December 2007
                Volume: 5
                Issue: 2
                Pages: 131-135
                Affiliations
                [1 ]Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
                [2 ]Department of Laboratory Medicine, Hanyang University Guri Hospital, Guri, Korea.
                Author notes
                Corresponding author: Sang-Woong Han, M.D. Department of Internal Medicine, Hanyang University Guri Hospital, 249-1 Gyomoon-dong, Guri, 471-701, Korea. Tel: +82-31-560-2231, Fax: +82-31-551-2239, cardion@ 123456hanyang.ac.kr
                Article
                DOI: 10.5049/EBP.2007.5.2.131
                PMC ID: 3894513
                PubMed ID: 24459512
                SO-VID: 83fb071c-cbc3-4d6a-89ce-5286ae486698
                Copyright © Copyright © 2007 The Korean Society of Electrolyte and Blood Pressure Research
                History
                Date received : 15 October 2007
                Date accepted : 25 October 2007
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: paraproteinemia,multiple myeloma,pseudohyperphosphatemia
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: paraproteinemia, multiple myeloma, pseudohyperphosphatemia

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