ROBERT G. NARINS, M.D.; THOMAS MURRAY, M.D.
To the editor: The cationic nature of myeloma paraproteins has been well documented (1, 2). The principle of electroneutrality requires that an equal concentration of anions be present to offset these added protein cations. Chloride and bicarbonate are retained to provide the negative charges, and the resulting hyperchloremia lowers the anion gap [Na-(Cl + HCO3)]. In this formulation each meq/litre increase in cationic protein should cause an equal and reciprocal decrease in the anion gap.
The technique of isoelectric focusing has shown that the paraprotein spike from each patient is composed of a group of protein bands with isoelectric points
NARINS RG, MURRAY T. Paraproteins and the Anion Gap. Ann Intern Med. ;87:117–118. doi: 10.7326/0003-4819-87-1-117_2
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Published: Ann Intern Med. 1977;87(1):117-118.
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