Recommended level of b2 microglobulin on dialysis. The influence of b2-microglobulin (b2M) on the course and prognosis of chronic lymphocytic leukemia (CLL). Preparation and execution

Cancer screenings

general characteristics

Beta-2-microglobulin is a low-molecular protein (11800 Da), a component of the light chain of the major histocompatibility complex class I (MHC I), present on all nucleated cells of the human body (except erythrocytes). In the blood - the level of beta-2-microglobulin reflects mainly thus, cell turnover and proliferation of lymphocytes, in which it is presented in large quantities. In urine - the level of beta-2-microglobulin increases due to impaired renal filtration (normally, only minimal amounts of proteins are detected in the urine, since most of the proteins are reabsorbed in the tubules ).

Indications for use

Blood is a marker for the development of diseases with activation of the cellular immune system (diseases lymphatic system), assessment of response to therapy and further prognosis. Urine is a highly sensitive marker for the differential diagnosis of glomerular and tubular damage; monitoring patients who have undergone kidney transplantation for early signs of rejection; monitoring of individuals exposed to high levels of cadmium and/or other heavy metals such as mercury, primarily due to occupational exposure; Serum and urine beta-2-microglobulin measurements - differentiating between lymphatic system activation and renal impairment (urine with protein molecules are unstable at acidic pH). Beta-2-microglobulin can accumulate in the joints (synovitis) in patients on long-term hemodialysis; this is called dialysis-associated amyloidosis. Beta-2-microglobulin testing can be used in comprehensive examination persons to identify dialysis-associated amyloidosis.

Marker

Marker of lymphoproliferative diseases. Marker of proximal tubular damage

Clinical relevance

Blood - assessment of the development of diseases with activation of the cellular immune system (diseases of the lymphatic system), assessment of response to therapy and further prognosis; Urine - differential diagnosis of glomerular and tubular damage; monitoring patients who have undergone kidney transplantation for early signs of rejection; monitoring of individuals exposed to high levels of cadmium and/or other heavy metals such as mercury, primarily due to occupational exposure; Serum and urine beta-2 microglobulin measurements - differentiating between lymphatic system activation and renal impairment. Beta-2 - microglobulin can accumulate in the joints (synovitis) in patients on long-term hemodialysis; this is called dialysis-associated amyloidosis. Beta-2-microglobulin testing can be used in a comprehensive examination of a person to identify amyloidosis associated with dialysis.

Composition of indicators:

Beta-2-microglobulin

Method : Chemiluminescent immunoassay
Measuring range : >0.004
Unit : Milligram per liter

Reference values:

Comments

Execution is possible on biomaterials:

Biological material

Delivery terms

Container

Serum

Delivery terms:

24 Hour. at temperatures from 2 to 25 degrees Celsius

Container:

Vacutainer with release gel

8.5 Milliliters

Patient preparation rules

In the morning before 11-00, on an empty stomach, after 8-12 hours of fasting. Maybe: during the working day of the branches of ML "DILA". Break for at least 6 hours after eating (exclude fatty foods)

Interference:

• X-ray contrasts
• In urine with an acidic pH, protein molecules are unstable.

Interpretation:

• In blood increased level beta-2-microglobulin reflects an increase in synthesis in conditions associated with increased activity of the immune system: multiple myeloma, Hodgkin's disease, chronic lymphocytic leukemia and other malignant non-Hodgkin's lymphomas. Other diseases with activation of the cellular immune system (infections, autoimmune diseases) also cause increased serum beta-2-microglobulin levels. HIV - inverse correlation between beta-2-microglobulin levels and CD4 + T lymphocytes. Elevated beta-2-microglobulin levels in the blood and low levels in the urine are characteristic of glomerular dysfunction. Elevated levels of beta-2-microglobulin in the urine and low levels in the blood are characteristic of kidney damage/disease. Elevated levels of beta-2-microglobulin in the blood and in the urine are characteristic of chronic lymphoid leukemia , non-Hodgkin's lymphoma and Hodgkin's lymphoma In urine - increased excretion of beta-2-microglobulin is observed in Wilson's disease, Fanconi syndrome, interstitial nephritis, diseases connective tissue (rheumatoid arthritis, Sjögren's syndrome), infections of the upper urinary tract, nephrotoxicity during therapy with cyclosporine, aminoglycosides, cisplatin. Highly sensitive for differentiating proximal tubular dysfunction, upper urinary tract infection from lower urinary tract infection, useful for diagnosing and monitoring the treatment of acute pyelonephritis. Increased levels of beta-2-microglobulin in the urine in patients on long-term hemodialysis occurs with amyloidosis associated with dialysis. Increased level Urinary beta-2-microglobulin in renal transplant patients may indicate early renal rejection. Elevated urinary beta-2-microglobulin levels in individuals exposed to high levels of cadmium or mercury may be an early marker of renal dysfunction.

There are various metabolites that belong to tumor markers, compounds indicating the presence of malignant tumors in the body. But some of these compounds are formed when tumors arise, and in healthy person practically never occur. Protein beta-2 microglobulin belongs to other compounds. It is found in almost all cells of our body, that is, it can also be found in healthy people. In addition to the cells of organs and tissues, it is also found in most physiological fluids, which include blood, urine, and some secretions. internal organs, as well as other liquid media. The greatest diagnostic value is provided by the study of beta-2 microglobulin in blood plasma, as well as in urine.

Study of beta-2 microglobulin in modern laboratories carried out using chemiluminescent immunoassay, which refers to, that is, immune methods. There is another name for this metabolite: thymotoxin, or β-2 M. Therefore, if you ordered an analysis for beta-2 microglobulin, and as a result you see beta-2 M, then you do not need to think that the laboratory made a mistake. This is the same name.

What role does this compound play in the body, and for what diseases and conditions can this analysis be useful in diagnostic searches?

β 2 M - what is it?

This protein is a light-weight compound, weighing up to 12 daltons. The function of this protein is quite complex; it is structural component the major histocompatibility complex, which is related to the recognition of “self or foe” signals. Contains microglobulin in all cells human body, which have kernels. Recall that there are no nuclei in one very large population of blood cells: this. They transport oxygen and carbon dioxide, and any foreign inclusions, including the nucleus, reduce the volume of the red blood cell, reducing the volume of transported oxygen and carbon dioxide molecules.

In adults, the content of microglobulin in the blood most reflects the function of lymphocytes, since it is in these cells that it is presented in the greatest number. This is not surprising, since it is the lymphocytes, which are trained in the immune organs to recognize their own and foreign compounds, that should be the most knowledgeable about all the “violators” of the immune system.

It is important that the rate of production of this substance is maintained at almost the same level and does not change throughout life. This protein is secreted by the kidneys, and only traces of this compound can be found in the urine of a healthy person. Thus, beta 2 microglobulin in the blood increases under conditions in which the immune system person experiences the greatest stress. These are various inflammatory processes, autoimmune pathology, reactions associated with transplant rejection in the body, as well as various malignant neoplasms of the blood that affect immune cells. These include, first of all, multiple myeloma and various lymphomas.

The amount of this protein increases sharply with a disease such as amyloidosis. Beta-2 microglobulin in the kidneys of patients with amyloidosis is able to condense and form long chains. They “clog” the membranes of the renal glomeruli, reduce the filtration rate, and thus the concentration of microglobulin in patients with amyloidosis can affect the activity of the process.

Due to the fact that microglobulin is a protein of insignificant molecular weight if he's in increased quantity are in the blood plasma, then it can accumulate in excess quantities in the cerebrospinal fluid or cerebrospinal fluid. The most common conditions and diseases that lead to this are lymphoma, leukemia, and viral infections. nervous system, for example, neuroAIDS in HIV infection.

When is analysis used? clinical practice, and what are the indications for the purpose of the study?

Why is analysis needed?

It is most often used as a tumor marker. Beta 2 microglobulin increases if the patient has leukemia associated with the degeneration of immunocompetent cells. These are various lymphomas. The second indication is to control the activity of the process in patients with amyloidosis. It must be remembered that a single study alone cannot make a diagnosis of amyloidosis.

One of the main indications for the purpose of this analysis is:

1. suspicion of multiple myeloma in the patient;
2. indirect determination of the stage of this malignant process.

It is also important to monitor microglobulin levels to assess the effectiveness of treatment. It was said above that its amount in a healthy person is constant, and if after the use of specific antitumor therapy its amount decreases, this may indicate the success of the treatment. After all, the total volume of this protein directly corresponds to the total amount of the tumor mass secreting it.

Important! Reducing beta-2 microglobulin levels in patients with diagnosed myeloma during treatment improves prognosis.

Plasma concentration testing of this metabolite is indicated in patients after kidney transplantation to detect the earliest signs of transplant rejection and take action. In some cases, the study of this protein helps to diagnose damage to the central nervous system during viral infections, and in the same myeloma, since it accumulates in the cerebrospinal fluid.

It is known that long-term exposure to industrial poisons such as cadmium and mercury can cause damage to the immune system and kidney tissue (toxic nephropathy). Therefore, in occupational pathology during chronic intoxication with cadmium and mercury, the level of this protein also reflects the activity of kidney damage. Does the patient need to prepare in any way for this test?

Preparing for the study

Preparing for the study of this tumor marker is not too difficult. It can be considered that this general recommendations to taking blood tests with minor additions. Thus, it is advisable to conduct this study in the morning, on an empty stomach, after a period of normal night sleep. You can drink water in the morning. The following recommendations are important:

• it is necessary to completely give up fatty foods one day before;
• 30 minutes before donating blood, excessive physical activity is prohibited;
• In the morning, before taking the test, it is advisable to eliminate stress, both domestic and work-related.

It is very important for smokers to know that every cigarette smoked earlier than 3 hours before the test can significantly distort its result.

Results and their deviations from the norm

Perhaps a person without medical education you don’t need to know all the subtleties of the fluctuations of this protein in the blood plasma of a healthy person of different ages. It can be said that:

• starting from the age of 19, that is, in adults, the norm of beta-2 microglobulin ranges from 0.67 to 2.329 mg per liter (mg/l) in blood plasma. There is no difference between men and women, just as there is no difference between a pregnant woman and a non-pregnant woman;
• beginning with childhood, and before reaching the age of 19 years, significant fluctuations in this metabolite occur in the blood plasma: the highest value of beta-2 microglobulin in the blood plasma occurs in infants. In babies, from the first day of life until they reach the age of one month, the value can reach 4.7 for boys and 4.5 mg per liter for girls.

This is natural, since microglobulin is a protein that ensures the functioning of the immune system, and the immune system grows and develops starting from early childhood, during the period when the body becomes familiar with various antigenic environmental factors, microorganisms, when becoming familiar with childhood infections, and so on.

Deviations from reference values

Despite the significant variation in reference values, it should be remembered that low levels of this protein are normal. And if they do not exceed 0, 7, or 0.9 mg per liter, then everything is fine, as well as with a value of 2.5 mg/l. The greatest concern is a significant increase in concentration, but it is definitely impossible to judge the nature of the pathology only from this analysis.

This may be a suspicion malignancy, for autoimmune diseases, which are treated by rheumatologists, and so on. A full examination is required. If the protein concentration is significantly exceeded, the patient first needs to consult a hematologist, since there is a suspicion of multiple myeloma, or a blood tumor.

If in a patient with myeloma after treatment the level of this protein decreases in relation to the initial one, then this fact indicates that the treatment has been correctly selected and the total amount of tumor mass has decreased. If in patients with myeloma the protein concentration in the blood plasma has not changed, or, on the contrary, has increased, then this indicates a worsening prognosis and (or) ineffective treatment.

If the patient has a symptom renal pathology, for example, protein in urine, high arterial pressure, edema, signs of nephropathy, then the level of microglobulin can be used to judge the dysfunction of the renal glomerular capsules. But this sign is important only if beta-2 microglobulin is high in the blood and low in the urine. If the situation is the opposite, and the metabolite has a low concentration in the blood plasma and a high concentration in the urine, then most often there is a disease associated with damage to the renal tubules. It is this fact that is important when chronic intoxication with mercury and cadmium is suspected. After all, these metals can cause damage specifically to the tubules, causing tubular necrosis.

If the level of this protein in the blood plasma increases in patients after kidney transplantation, this may indicate the onset of a serious complication: the onset of transplant rejection.

The study of beta-2 microglobulin in blood plasma is one of those tests that, if permissible standards are exceeded, entail a full range of laboratory and instrumental methods research. From the above it is clear that an increase, even a significant one, of this substance in the blood plasma cannot be unambiguously considered a sign of either a malignant disease or kidney damage. Needed additional methods research.

In addition, changes in the concentration of microglobulin in the blood plasma can be influenced by various severe infectious processes and medications, such as aminoglycoside antibiotics, lithium preparations, and cytostatics. If the patient takes this test soon after computed tomography or MRI using contrast agents, such as Omnipaque, can also lead to false positive results and increased protein concentrations in the blood.

Beta 2-microglobulin (Beta-2-MG) is a low molecular weight protein and an important cancer marker. Located on the surface of nucleated cells in the form of a light chain of the major histocompatibility complex antigen - HLA. The presence of this protein in blood serum is explained by the processes of degradation and repair of cell elements. The level of Beta-2-microglobulin in the blood characterizes cell turnover and proliferation of lymphocytes.

The material for the study is urine and blood serum. Elevated levels of Beta 2-microglobulin are observed in the following conditions:

Autoimmune diseases, changes in cellular immunity (for example, AIDS),
- conditions after organ transplantation,
- spicy viral infections,
- renal failure,
- chronic lymphocytic leukemia, lymphoma with central nervous system involvement, multiple myeloma.

Therefore, analysis for the content of the tumor marker B-2-MG is carried out for prognostic purposes in oncohematology, as well as to assess the activity of the process in autoimmune diseases and to monitor renal graft function (to assess survival).

In addition, an increased level of the tumor marker Beta-2-MG is observed in the blood serum during intoxication with heavy metal salts (for example, cadmium salts) and during diabetic nephropathy. Beta-2-MG analysis in blood serum and urine is performed to diagnose tubular nephropathies and glomerulonephritis.

An increase in the level of Beta 2-microglobulin in the cerebrospinal fluid in patients suffering from leukemia indicates involvement of the central nervous system in the pathological process.

Beta 2-microglobulin levels are determined to determine prognosis in patients with non-Hodgkin's lymphoma and multiple myeloma. Patients with elevated levels of Beta-2-MG usually have a shorter life expectancy than patients with higher low level of this tumor marker. The level of the beta2-MG tumor marker is also monitored during the treatment of hematological malignancies and when monitoring the activation of lymphocytes during kidney transplantation.

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Many studies have confirmed the prognostic significance of the level b2-microglobulin (b2M) in blood serum. b2-Microglobulin is the L-chain of the class I histocompatibility molecule. It is associated with one of the immunoglobulin-like regions (domains) of the part of the a-chain of the molecule located on the cell surface and serves as a stabilizer of the molecule.

b2-microglobulin is always found in small quantities in serum. Numerous works have shown that b2-microglobulin level in the blood serum above 3.5-4.0 mg/l is a poor prognostic sign for many lymphoproliferative diseases, including. For the first time, a correlation between increased levels of b2-microglobulin in the blood serum and the progressive course of chronic lymphocytic leukemia installed more than 15 years ago.

It was subsequently shown that high b2-microglobulin level in the early stage of the disease is an independent prognostic sign, predicting rapid progression. The greater prognostic value of the level of b2-microglobulin in the blood serum than the stage of the disease was confirmed in an analysis of the course of chronic lymphocytic leukemia in 622 patients observed at the MD Anderson Cancer Center. Employees of this center discovered a correlation between the level of b2-microglobulin in the blood serum and the level of IL-6.

In a multivariate analysis, including the stage of the disease, hemoglobin content, number of leukocytes and platelets, b2-microglobulin level And IL-6 in 100 patients, it was shown that only b2-microglobulin levels above 3.5 mg/l are an independent factor of poor prognosis.

Some studies report that b2-microglobulin level correlates with the level of cyclin D1, which is a member of the family of cyclin-dependent kinases that regulate cell cycle. Increased levels of cyclin D1, as well as levels of b2-microglobulin, predict a more rapid progression of the disease.

Beta-2-microglobulin is a protein that is found on the surface of almost all cells in the body. It is present in most physiological fluids. Its content in the blood increases in cancers such as myeloma, leukemia and lymphoma, as well as in inflammatory processes.

Synonyms Russian

Timotaxin.

English synonyms

B2M, B 2 M, Thymotaxin, Beta 2 -Microglobulin.

Research method

Chemiluminescent immunoassay.

Units

Mg/l (milligrams per liter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

1. Eliminate fatty foods from your diet for 24 hours before the test.
2. Avoid physical and emotional stress 30 minutes before the test.
3. Do not smoke 3 hours before the test.

General information about the study

The protein beta-2-microglobulin is found on the surface of almost all cells of the human body. It is present in most physiological fluids, and its serum level increases in multiple myeloma, lymphoma and inflammatory processes in the body. The test determines the content of beta-2-microglobulin in the blood, urine and occasionally in the cerebrospinal fluid.

In the kidneys, beta-2 microglobulin passes through the filters of the capsules of the renal glomerulus and is then absorbed by the renal tubules, which filter back water, proteins, vitamins, salts and other substances necessary for the body. Normally, only a small amount of beta-2-microglobulin is found in the urine, but if the renal tubules are damaged or infected, its concentration increases due to decreased reabsorption. After undergoing dialysis in patients suffering from kidney disease, beta-2-microglobulin can form long molecular chains that form deposits in joints and tissues, causing discomfort and pain. This disease is called beta-2-microglobulin dialysis-associated amyloidosis.

Beta-2-microglobulin levels are sometimes elevated in the cerebrospinal fluid in leukemia and lymphoma and such chronic diseases, like multiple sclerosis and viruses like HIV, which affect the brain.

What is the research used for?

• As a tumor marker for some blood cell cancers, as well as for detecting kidney damage and distinguishing between glomerular and tubular kidney diseases. The beta-2-microglobulin test does not diagnose the disease, but it does Additional information relatively probable development disease, as well as regarding the condition of the patient’s kidneys.
• To determine the severity of multiple myeloma and identify the stage of the disease, sometimes to evaluate the effectiveness of treatment. Beta-2-microglobulin is associated with tumor burden and may help predict the prognosis of cancers such as leukemia and lymphoma.
• To assess the extent of kidney damage, and to distinguish between diseases affecting the glomerular capsules and the renal tubules (together with other kidney function tests: blood urea nitrogen, creatine and microalbumin tests).
• To evaluate kidney transplant patients for signs of rejection, and to monitor patients who have been exposed to high concentrations of cadmium and mercury.
• To find out how much the disease affects the central nervous system.

When is the study scheduled?

• In the event of a diagnosis of multiple myeloma, in order to establish what stage the disease is at and to periodically monitor the effectiveness of treatment. In addition, this test is often necessary in leukemia and lymphoma to help predict the future progression of the disease.
• For symptoms of kidney dysfunction and in cases where it is necessary to determine whether the disease affects the capsules of the renal glomerulus or the renal tubules.
• We periodically examine patients with transplanted kidneys and patients exposed to elevated concentrations of cadmium and mercury.
• If diseases such as leukemia and lymphoma are suspected of affecting the central nervous system.

What do the results mean?

Reference values mg/l

• Elevated levels of beta-2 microglobulin indicate a problem, but do not diagnose any disease. The results of the analysis reflect the activity of the disease and the size of the tumor mass.
• If the level of beta-2-microglobulin in the blood is significantly elevated when diagnosed with multiple myeloma, leukemia or lymphoma, the prognosis of the disease is poor.
• A decrease in the concentration of this protein during the treatment of multiple myeloma indicates positive reaction in response to treatment, unchanged or increasing levels – in response to ineffective therapy.
• If there are signs of kidney disease, an increased level of beta-2-microglobulin in the blood and a decreased level in the urine indicate that the cause of the disorder is associated with dysfunction of the glomerular capsules. If the level of beta-2-microglobulin is low in the blood and, on the contrary, high in the urine, then it is likely that the cause of the pathology is damage to the renal tubules.
• An increase in beta-2-microglobulin levels after kidney transplantation sometimes indicates the onset of organ rejection. Meanwhile, the onset of kidney dysfunction may be indicated by an increase in beta-2-microglobulin levels due to contact with high concentrations of cadmium and mercury.
• An increase in beta-2-microglobulin in the cerebrospinal fluid in diseases such as leukemia or HIV/AIDS indicates that the disease has affected the central nervous system.
• Low levels of beta-2-microglobulin are considered normal. Beta-2-microglobulin levels may be undetectable in urine and cerebrospinal fluid.

What can influence the result?