Evaluation of patients with nephrotic syndrome and pancreatitis
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Alpha-2-macroglobulin is a protease inhibitor and is 1 of the largest plasma proteins. It transports hormones and enzymes, exhibits effector and inhibitor functions in the development of the lymphatic system, and inhibits components of the complement system and hemostasis system.
Increased levels of alpha-2-macroglobulin are found in nephrotic syndrome when other lower molecular weight proteins are lost and alpha-2-macroglobulin is retained because of its large size. In patients with liver cirrhosis and diabetes, the levels are found to be elevated.
Patients with acute pancreatitis exhibit low serum concentrations which correlate with the severity of the disease. In hyperfibrinolytic states, after major surgery, in septicemia and severe hepatic insufficiency, the measured levels of alpha-2-macroglobulin are often low. Acute myocardial infarction patients with low alpha-2-macroglobulin have been reported to have a significantly better prognosis with regard to the >1 year survival time.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Values are elevated in the nephrotic syndrome in proportion to the severity of protein loss (lower molecular weight).
Values are low in proteolytic diseases such as pancreatitis.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Deficiency or increase may be seen as elevated or decreased alpha-2 peaks on serum protein electrophoresis.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. McMahon MJ, Bowen M, Mayer AD, Cooper EH: Relation of alpha-2-macroglobulin and other antiproteases to the clinical features of acute pancreatitis. Am J Surg 1984;147:164-170
2. Haines AP, Howarth D, North WR, et al: Haemostatic variables and the outcome of myocardial infarction. Thromb Haemost 1983;50:800-803
3. Hofmann W, Schmidt D, Guder WG, Edel HH: Differentiation of hematuria by quantitative determination of urinary marker proteins. Klin Wochenschr 1991;69:68-75
4. Solerte SB, Adamo S, Viola C, et al: Acute-phase protein reactants pattern and alpha 2 macroglobulin in diabetes mellitus. Pathophysiological aspects in diabetic microangiopathy. La RIC Clin Lab 1994;14:575-579
5. Silverman LM, Christenson RH, Grant GH: Basic chemistry of amino acids and proteins. In Clinical Guide to Laboratory Tests. Second edition. Edited by NW Tietz. Philadelphia, WB Saunders Company, 1990, pp 380-381