What are the symptoms of decompression sickness. How can divers prevent the bends. What is the proper treatment for suspected cases of DCS. Why is denial a dangerous symptom of decompression sickness. How does emergency oxygen help in cases of the bends.

Understanding Decompression Sickness: The Silent Threat to Divers

Decompression sickness (DCS), commonly known as “the bends,” is a potentially life-threatening condition that can affect scuba divers. It occurs when dissolved gases, primarily nitrogen, form bubbles in the blood and tissues as a diver ascends too quickly from depth. These bubbles can cause a range of symptoms, from mild joint pain to severe neurological issues.

While DCS is relatively rare, understanding its causes, symptoms, and treatment is crucial for every diver. This knowledge can mean the difference between a quick recovery and long-term health complications.

What causes decompression sickness?

Decompression sickness is primarily caused by:

• Rapid ascents from depth
• Exceeding no-decompression limits
• Flying too soon after diving
• Repetitive dives without adequate surface intervals

As a diver descends, the increased pressure causes nitrogen to dissolve into the body’s tissues. During ascent, this nitrogen must be released slowly through normal respiration. If the ascent is too rapid, the nitrogen can form bubbles, leading to DCS.

Recognizing the Symptoms of Decompression Sickness

Symptoms of DCS can manifest immediately after surfacing or up to 24 hours later. On average, divers experience symptoms between 15 minutes and 12 hours following a dive. Recognizing these symptoms early is crucial for prompt treatment and the best possible outcome.

Common symptoms of decompression sickness

• Unusual fatigue
• Itchy skin
• Joint and muscle pain in arms, legs, or torso
• Dizziness and vertigo
• Ringing in the ears
• Numbness and tingling sensations
• Shortness of breath
• Paralysis (in severe cases)

Observable signs of DCS

• Blotchy rash
• Muscle weakness or paralysis
• Difficulty urinating
• Confusion or personality changes
• Staggering gait
• Coughing up bloody, frothy sputum
• Collapse or unconsciousness

Do all cases of decompression sickness present the same symptoms? No, the severity and presentation of DCS can vary widely. Some divers may experience only mild joint pain, while others may face life-threatening neurological symptoms. This variability underscores the importance of seeking medical evaluation for any suspected case of DCS, regardless of how minor the symptoms may seem.

Immediate Response: Treating Suspected Decompression Sickness

When faced with a suspected case of decompression sickness, quick and appropriate action is crucial. The first and most important step is to administer 100% oxygen immediately. This helps to reduce the size of nitrogen bubbles and improve the body’s ability to eliminate excess gas.

Categorizing DCS severity

DCS cases can be broadly categorized into three levels of severity:

1. Emergency DCS
2. Urgent DCS
3. Timely DCS

Emergency DCS: When every second counts

Emergency DCS is characterized by severe symptoms such as:

• Profound dizziness
• Intermittent consciousness
• Extreme weakness
• Abnormal gait
• Breathing difficulties

In cases of emergency DCS, what should be the immediate course of action? Administer 100% oxygen without delay and arrange for emergency evacuation to the nearest medical facility. It’s crucial to contact emergency medical services first, followed by Divers Alert Network (DAN). While recompression is necessary, stabilization at a medical facility takes precedence before transportation to a hyperbaric chamber.

Urgent DCS: Balancing quick response with careful assessment

Urgent DCS typically involves severe, constant, or increasing pain. The protocol for urgent cases includes:

1. Administering 100% oxygen
2. Providing fluids to the diver
3. Contacting DAN or the nearest medical facility
4. Conducting a neurological examination
5. Gathering information about recent diving activity

Why is it important to avoid giving pain relievers to a diver with suspected DCS? Pain relievers can mask symptoms, making it more difficult for medical professionals to accurately assess the severity of the condition and potentially leading to inadequate treatment.

Timely DCS: The importance of vigilance

Timely cases of DCS may present with vague complaints or symptoms that develop slowly over several days. Even in these less urgent scenarios, it’s crucial to:

• Conduct a neurological assessment
• Collect information about recent diving activity
• Contact DAN or a medical professional for advice
• Seek evaluation at a medical facility

The Role of Emergency Oxygen in DCS Treatment

Emergency oxygen plays a pivotal role in the initial treatment of decompression sickness. By providing 100% oxygen, you can significantly improve the diver’s condition and potentially reduce the severity of DCS.

How does emergency oxygen help in DCS cases?

Emergency oxygen aids in DCS treatment by:

• Reducing the size of nitrogen bubbles in the body
• Increasing the rate of nitrogen elimination
• Improving oxygenation of tissues
• Potentially alleviating some symptoms

Can emergency oxygen completely cure decompression sickness? No, while emergency oxygen is a crucial first step in treating DCS, it is not a substitute for proper medical evaluation and treatment. In some cases, symptoms may temporarily improve with oxygen administration only to reappear later. This underscores the importance of seeking professional medical care even if symptoms appear to resolve.

Denial: The Hidden Danger in Decompression Sickness

One of the most insidious aspects of decompression sickness is the tendency for affected divers to deny or downplay their symptoms. This denial can lead to delayed treatment, potentially resulting in permanent injury or prolonged recovery times.

Why do divers sometimes deny DCS symptoms?

Several factors can contribute to denial in DCS cases:

• Fear of admitting to a diving mistake
• Concern about medical expenses
• Reluctance to “make a fuss” or inconvenience others
• Hope that mild symptoms will resolve on their own
• Lack of awareness about the potential severity of DCS

How can the diving community combat the problem of denial in DCS cases? Education is key. By fostering a culture of safety and open communication, we can encourage divers to report symptoms promptly and without fear of judgment. Additionally, emphasizing that even mild symptoms warrant medical evaluation can help overcome the tendency to dismiss early signs of DCS.

Prevention: The Best Defense Against Decompression Sickness

While treatment options for DCS have improved significantly over the years, prevention remains the best strategy for avoiding this potentially debilitating condition. By following established safety guidelines and best practices, divers can significantly reduce their risk of developing decompression sickness.

Key strategies for preventing decompression sickness

• Adhere to recommended ascent rates (typically 30 feet per minute or slower)
• Perform safety stops on all dives, even those within no-decompression limits
• Use dive computers and follow their guidance
• Stay well-hydrated before, during, and after diving
• Avoid alcohol and strenuous exercise before and after diving
• Allow adequate surface intervals between dives
• Follow flying-after-diving guidelines (typically waiting 12-24 hours before flying)
• Dive conservatively, especially in challenging conditions or at altitude

Is it possible to completely eliminate the risk of decompression sickness? While it’s not possible to eliminate all risk, following these preventive measures can significantly reduce the likelihood of developing DCS. It’s important to remember that even experienced divers following all safety protocols can occasionally develop decompression sickness, which is why recognizing symptoms and seeking prompt treatment remains crucial.

The importance of proper dive planning

Effective dive planning plays a crucial role in preventing decompression sickness. This includes:

1. Assessing personal fitness and readiness to dive
2. Evaluating environmental conditions
3. Setting conservative depth and time limits
4. Planning appropriate gas mixtures for the dive
5. Ensuring proper equipment maintenance and functionality
6. Discussing emergency procedures with dive buddies

The Role of Dive Insurance in Managing DCS Risk

While prevention is paramount, being prepared for the possibility of decompression sickness is equally important. Dive insurance plays a crucial role in ensuring that divers have access to proper care in the event of a diving-related injury or illness.

Benefits of dive insurance

Dive insurance typically offers:

• Coverage for emergency medical treatment, including hyperbaric oxygen therapy
• Evacuation and transportation to appropriate medical facilities
• 24/7 access to diving medicine specialists for consultation
• Coverage for lost diving days due to illness or injury
• Legal support in case of diving-related incidents

Why is dive insurance particularly important for decompression sickness cases? DCS treatment often involves expensive hyperbaric oxygen therapy, which may require multiple sessions. Additionally, severe cases might necessitate emergency evacuation or transfer to specialized facilities. Without insurance, these costs can be prohibitively expensive, potentially leading divers to delay or forego necessary treatment.

Choosing the right dive insurance

When selecting dive insurance, consider:

1. Coverage limits for various scenarios
2. Geographical coverage area
3. Exclusions and limitations
4. Reputation and responsiveness of the insurance provider
5. Additional benefits such as gear replacement or trip interruption coverage

Organizations like Divers Alert Network (DAN) offer specialized dive insurance policies tailored to the unique needs of scuba divers. These policies often include access to diving medicine experts and can provide peace of mind for divers exploring remote or challenging dive sites.

Advancing Our Understanding of Decompression Sickness

While we have come a long way in understanding and treating decompression sickness, there is still much to learn. Ongoing research continues to shed light on the mechanisms underlying DCS and potential new treatment approaches.

Current areas of DCS research

Scientists and diving medicine specialists are exploring:

• Genetic factors that may influence susceptibility to DCS
• Advanced decompression algorithms for dive computers
• The role of microbubbles in DCS development
• Novel treatments, including the use of nitric oxide and perfluorocarbons
• Long-term effects of subclinical decompression stress
• Improving recompression protocols for more effective treatment

How might advances in DCS research impact diving practices in the future? As our understanding of decompression sickness grows, we may see more personalized approaches to dive planning, taking into account individual risk factors. Additionally, improvements in treatment protocols could lead to better outcomes for divers affected by DCS, potentially reducing long-term complications.

The importance of diver participation in research

Divers can contribute to the advancement of DCS research by:

1. Participating in diving physiology studies
2. Accurately reporting incidents and near-misses
3. Sharing dive computer data for analysis
4. Supporting organizations dedicated to dive safety research
5. Staying informed about the latest developments in diving medicine

By actively engaging with the scientific community, divers can play a crucial role in improving dive safety for themselves and future generations of underwater explorers.

Decompression sickness remains a significant concern in the diving community, but with proper education, prevention strategies, and prompt treatment, its impact can be minimized. By staying informed about the latest developments in diving medicine and adhering to safe diving practices, divers can continue to enjoy the wonders of the underwater world while managing the risks associated with this challenging environment.

Treating Decompression Sickness (The Bends)

Decompression sickness (DCS) is one of the most common problems reported to Divers Alert Network^® (DAN^®). Although scuba diving accidents are rare, it’s important to know how to handle suspected cases of DCS. Your ability to take appropriate action can make a difference in the life of someone you care about.

What is Decompression Sickness?

DCS, also known as the bends, describes a variety of injuries that result from inadequate decompression following exposure to increased pressure. This can occur following uneventful dives within accepted no-decompression limits but is more likely after dives that involve a rapid underwater ascent. DCS can also be prompted by ascending in an airplane too soon after diving. When there is a rapid decrease in surrounding pressure, nitrogen absorbed by the body at depth comes out of solution, creating bubbles in the bloodstream and/or body tissues.

Symptoms of DCS can occur immediately after surfacing or up to 24 hours later. On average a diver with DCS will experience symptoms between 15 minutes and 12 hours following a dive.

Symptoms of DCS

• Unusual fatigue
• Itchy skin
• Pain in the joints and/or muscles of the arms, legs or torso
• Dizziness, vertigo and ringing in the ears
• Numbness, tingling and paralysis
• Shortness of breath

Signs of DCS

• Blotchy rash
• Muscle weakness or paralysis
• Difficulty urinating
• Confusion, personality changes or bizarre behavior
• Staggering
• Coughing up bloody, frothy sputum
• Collapse or unconsciousness

How to Treat a Diver with Suspected DCS

If you suspect a diver has DCS, provide emergency oxygen right away. Next, determine the severity of their condition (emergency, urgent or timely) by following the guidelines below:

Emergency DCS

A diver who is profoundly dizzy, intermittently conscious, weak, walking with an abnormal gait or having trouble breathing is experiencing a serious medical emergency. Administer 100 percent oxygen, and arrange emergency evacuation to the nearest medical facility.

Always contact emergency medical services first, then contact DAN. Although a diver with severe DCS requires recompression, it is essential that he or she be stabilized at the nearest medical facility before transportation to a chamber.

Urgent DCS

A diver experiencing severe pain that is either constant or increasing should be placed on 100 percent oxygen and given fluids. The next step is to contact DAN or the nearest medical facility. Emergency air transportation may not be necessary in all cases. Do not give the diver analgesics (pain relievers) unless advised to do so by medical personnel.

After obtaining professional medical advice, conduct a neurological exam and write down as much information as you can about the diver’s recent diving activity. A neurological exam can be done by anyone; no medical experience or training is required. Simply follow the on-site neuro exam directions found here. Ask the diver about any diving activities within the past 48 hours, including depths, times, ascent rates, surface intervals, breathing gas used and any problems experienced during or after the dives.

Obtain as much info as you can without delaying transportation to a medical treatment facility. If time allows, the following additional information may aid medical professionals with diagnosis and treatment:

• Symptom onset times and progression after the diver surfaced from their last dive
• A list of all first aid measures taken (including times and method of oxygen delivery) and their effect on symptoms
• A description of any joint or other musculoskeletal pain including location, intensity and changes based on movement or weight-bearing maneuvers
• Photos of any rashes with a detailed description of their location
• Information about any traumatic injuries sustained before, during or after the dive

Timely Cases of DCS

Divers who do not have obvious symptoms or whose symptoms develop slowly over multiple days may have a “timely” case of the bends. Common signs and symptoms may include vague complaints of pain or abnormal sensations.

Follow the steps described previously under “Urgent DCS” to conduct a neurological assessment and collect information about the diver’s recent activity. Next, contact DAN or a medical professional, or go to the nearest medical facility for advice and further evaluation.

Denial: The Worst Symptom of DCS

Denial is arguably the worst “symptom” of DCS. Delayed treatment can lead to permanent injury and prolong (or even prevent) the diver’s full recovery. Emergency oxygen can cause symptoms to temporarily improve only to reappear later — it is no substitute for a medical evaluation. Always contact DAN or a medical professional with training in dive medicine in cases of suspected DCS — even if the symptoms and signs appear to have resolved. 

Be Prepared, Get Insured

Dive accidents can happen to anyone, not just newly certified divers. According to a recent DAN Annual Diving Report, nearly 600 divers contacted DAN with concerns about DCS, and divers with 21-60 logged dives were the most likely to report a diving incident. Learn more about the Top 5 Factors That Increase a Diver’s Risk of Getting the Bends.

Many medical insurance plans cover only the cost of hyperbaric treatments and not the cost of getting you to the chamber (the average cost for an air ambulance is around US$20,000). Ensure you have protection against the unexpected by purchasing DAN Dive Accident Insurance.  

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Brand history: 130 years of Mercedes-Benz

Illustrations provided by the press service of Mercedes-Benz RUS

The Mercedes-Benz brand for motorists from all over the world is not only one of the most recognizable and significant car manufacturers in the world, but also directly associated with the very concept of “car”. And this is justified at least by the historical significance of the brand: exactly 130 years ago, the German engineer Karl Benz officially filed a patent for a “vehicle with a gasoline engine.”

The event that marked the beginning of the history of not only the German brand, but the entire world automobile industry, occurred on January 29, 1886. It was on this day that a German engineer and innovator named Benz received patent No. 37435 for his creation – the world’s first car with a gasoline engine.

Of course, Benz’s invention was very different from the modern image of the car: in fact, he installed a four-stroke engine he developed from scratch on a tricycle.

In the same year, independently of Benz, design engineer Gottlieb Daimler created his own motorized carriage. Daimler assembled a single cylinder four-stroke internal combustion engine. It was supposed to be installed in carriages. Daimler was assisted in the development of the new technology by engineer Wilhelm Maybach. Karl Benz, Gottlieb Daimler and

Wilhelm Maybach

Both engineers founded private companies with the help of partners and investors. Benz founded Benz & Cie in Mannheim in October 1883, and Daimler founded the Daimler-Motoren-Gesellschaft (DMG) brand in November 1890. From 1901, Daimler’s company began to produce cars under the Mercedes brand.

The legendary brand got its name from the nickname of the daughter of the Austrian businessman Emil Jellinek named Adriana (Mercedes is the girl’s nickname). Her father, Honorary Vice Consul in Monaco, was wealthy and interested in modern technology. At his request in 189In the year 7, Gottlieb Daimler installed a 6 horsepower two-cylinder engine on a vehicle. After the success of this project, he ordered 4 more copies and sold them at a profit.

The same Mercedes She had a four-cylinder engine with a volume of almost 6 liters. and a power of 35 hp. The car was characterized by a wide wheelbase, a low center of gravity and an inclined steering column.

A honeycomb-type cooler has also become a distinguishing feature of the brand. The car weighed 900 kg and had a top speed of 80 km/h. The model was designed by Wilhelm Maybach himself.

The first cars and engines of the Mercedes brand

The merger of the two most famous German manufacturers at that time took place in 1926. Thanks to the deal, the industrialists not only managed to survive in the difficult post-war period, but also significantly expanded their business.

The united concern was named “Daimler-Benz AG”, and another outstanding German designer Ferdinand Porsche became the first head, and later – the creator of another legendary Porsche brand.

All cars produced after the merger are named Mercedes-Benz, in honor of the company’s most successful car and its creator, Karl Benz.

The Daimler-Benz AG logo becomes a three-pointed star, which is framed by a wreath – the legacy of the Benz logo. In the future, this wreath will be turned into a regular circle, which is still used today. One of the simplest (and recognizable) logos in history has become a symbol of luxury and wealth.

Mercedes logo

The collaboration between Benz and Daimler turned out to be one of the longest in the history of the automotive industry, as both companies in this combination survived until 1998. Their first joint car was the K.

At the same time, the Mercedes CCK and SSKL, designed by Hans Niebel, appeared. In addition to the typical sports versions, the manufacturer also offers convertibles and production models with rally-adapted bodywork.

Daimler-Benz AG produces one legendary series after another. So, under the leadership of Ferdinand Porsche, the “S” series, a new generation of sports cars, appeared. The most famous car and the progenitor of the S-series was the car that was popularly nicknamed the “Death Trap”. Having received the name “Mercedes-Benz 24/100/140”, the car had a powerful six-cylinder engine and developed a high speed for those times – up to 140 km / h.

The 18/80 HP model, known as the Nürburg 460 (1928), also received fame, equipped with an eight-cylinder engine with a displacement of 4622 cc. cm and a maximum power of 80 liters. With. at 3400 rpm; the 500K and 540K roadsters (30s) and the 770 model called Grosser Mercedes, whose first generation was built from 1930 to 1938. The model had a luxurious salon in which Adolf Hitler moved.

Advertising 770

The first model and mass production of the diesel Mercedes 260D was launched from 1936 to 1940. The 2.5 liter diesel engine had a power of 45 hp. With. Some of the cars of this brand were subsequently used by the German army.

World War II almost destroyed the Daimler-Benz AG business. All production facilities of the company were practically destroyed. Factories in Stuttgart, Sindelfingen and Mannheim literally turned into a pile of rubble. In 1945, after the final meeting of the board of directors, a report was even issued, the result of which was the idea that the Daimler-Benz concern no longer exists.

However, despite all the difficulties, Daimler-Benz AG recovered quickly enough and in 1947 launched the 170 model, which had an engine capacity of 1767 m³, 4 cylinders and a power of 52 hp. With. A car that was completely different from previous models was the Mercedes 300 – a limousine formed on a frame with crossed beams. It was equipped with a three-liter six-cylinder engine with 115 hp. s., and its special version was created for the first German Federal Chancellor Konrad Adenauer.

Among the cars produced by Mercedes-Benz after the Second World War, the 300 SL Coupe stands out with its characteristic “winged” doors that opened with part of the roof. It was the first sports car built after the war. The road version of this unusual vehicle was released in 1954.

Mercedes-Benz 300 SL Coupe

In February 1954, the 300 SL appeared. March 1957 years began to produce the model 300 SL Roadster, beloved by Elvis Presley.

Cars produced in the 70-90s became iconic for the brand.

In 1975-1986, the Mercedes W123, popularly known as the “barrel”, was formed. In the 80s, the 190 model debuted, which was produced in the years from 1982 to 1993 and replaced by the C class. At the same time, the popular Mercedes W124 appeared, which was produced until 1997. After that, the W210 appears on the market, since 2002 it has been replaced by the W211, W212 versions. It is these models that are called class E.

Mercedes-Benz W211

In 1998, Mercedes buys back shares of the American company Chrysler. As a result, Daimler-Benz has gained a chance to get wider access to the US market. This agreement changed the corporate name of the company to Daimler Chrysler, the cooperation continued for almost 10 years. The decision to break off cooperation was influenced by the results of the poor financial condition of Chrysler. After the sale of the shares of the American concern, the company returns the name Daimler AG.

Today, the company manufactures Mercedes A, B, C and E class models. The brand’s modern cars are renowned for their safety and are still considered the most prestigious in the world. Mercedes S Class even entered the Book of Records as “the most durable car that has ever been released.”

Andrey Rodionov, Head of Corporate Communication at Mercedes-Benz RUS JSC

– When 130 years ago Karl Benz applied for a patent for “a vehicle powered by a gasoline engine” it meant the birth of the automobile. In the same year, Gottlieb Daimler created his own car. Thus began the 130-year success story of Mercedes-Benz, we entered the age of speed and the global automotive industry was born.

The patent became part of the UNESCO Memory of the World program, among such well-known works as the Gutenberg Bible, Magna Carta and Symphony No. 9 in D minor by J.S. Bach. And it is no accident: the inventions of Karl Benz and Gottlieb Daimler, thanks to their ingenuity and entrepreneurial flair, revolutionized the field of transportation, opening up new opportunities for people.

Today’s innovations are based on the same values ​​as 130 years ago: safety, comfort, efficiency and faith in success. Thanks to them, the brand demonstrates a dynamic growth in global sales, and in Russia in 2015 it is a confident leader in the premium segment. Mercedes-Benz delights its fans with the premieres expected in Russia – this is the new intelligent E-Class, the chic GLS, the sporty SL and SLC. And, of course, new special offers.

Mercedes-Benz ads have also always stood out for their trademark execution and creativity – the brand has never spared money on marketing.

Advertisement for the BlueEFFICIENCY system (the system is a technical solution for optimizing fuel consumption and emissions).

A billboard was placed at Johannesburg Airport, which was originally just a white surface and the Mercedes-Benz logo. After a while, air pollutants accumulated on the billboard, and the message was clearly visible on the white base: “If more cars had BlueEFFICIENCY, you would not be able to read this. ”

Mercedes-Benz B-Class Prints Designed by Shanghai Berlin Agency

“Left Brain, Right Brain” advertising campaign , right hemisphere”)

Mercedes image ad for breast cancer

2010

2011

2013

2014 Marilyn Monroe

9 0004

Protein Benz- Jones in the urine, quantitatively (urine immunofixation)

Detection of free light chains of immunoglobulins (Bence-Jones protein) in the urine, used to diagnose monoclonal gammopathies, including multiple myeloma.

Synonyms Russian

Free light chains of immunoglobulins in urine, M-gradient.

Synonyms English

Bence-Jones protein, Urine (immunofixation)

Free light chains, Urine

Urinary FLC

90 269 Research method

Immunofixation.

Which biomaterial can be used for research?

Daily urine, mid-morning urine.

General information about the study

Bence-Jones protein is a group of monoclonal free immunoglobulin light chains that can be detected in urine or blood. Their appearance is characteristic of lymphoproliferative diseases such as multiple myeloma. This feature was first described by the English physician Henry Bence-Jones while examining a urine sample, which gave it its name. Subsequently, it became known that the Bence-Jones protein is, in fact, a homogeneous group of free light chains of immunoglobulins synthesized by a single plasma cell (monoclonal). The Bence-Jones protein is the collective name for monomers, dimers, tetramers, and other polymeric structures made up of immunoglobulin light chains.

Free chains of immunoglobulins are polypeptides with a molecular weight of 22 kDa, which are synthesized by plasma cells and, when combined with heavy chains, form immunoglobulin molecules of various classes: IgG, IgM, IgA and others. Depending on the structure of the constant domain, two classes of light chains are distinguished – lambda (λ) and kappa (κ) chains. Each immunoglobulin can have only one class of light chains – either lambda or kappa. Normally, plasma cells synthesize more light chains than heavy chains. Light chains that are not included in the composition of immunoglobulins are called free. Free kappa chains generally exist as a monomer, are small in size, and are therefore relatively easy to filter into primary urine. Lambda chains, in contrast, usually exist in dimeric form, making them difficult to filter in the glomerulus. In rare cases, both kappa and lambda chains can form tetramers, large complexes of proteins that do not pass into the urine. Normally, almost all of the light chains that enter the renal tubules are reabsorbed, and only a small part of them is excreted in the urine (no more than 0.75-1.8 mg / l). The appearance of an excess of free light chains of immunoglobulins in the urine (the appearance of Bence-Jones protein) may indicate their excessive production by plasma cells (gammapathies) or a violation of the process of renal reabsorption (kidney disease). Bence-Jones protein detection can be used to diagnose and monitor the treatment of these diseases.

Bence-Jones protein is determined in 50-70% of patients with multiple myeloma, 30-40% of patients with Waldenström’s macroglobulinemia and in 90% of patients with primary amyloidosis. Other conditions in which Bence-Jones protein can be observed in the urine are lymphoma, leukemia (more often chronic lymphocytic leukemia or plasma cell leukemia), pancreatic cancer, medullary thyroid carcinoma, benign gammopathy of unknown origin. In the absence of any reason for the appearance of this protein in the urine, they speak of idiopathic Bence-Jones proteinuria.

Immunoglobulin free light chains cannot be detected by routine urinalysis – special tests are used for this. As a rule, laboratory diagnostics for suspected gammopathy begins with conventional electrophoresis of plasma and urine proteins. This step is necessary to determine the concentration of the M-protein (paraprotein) and the initial differential diagnosis of gammopathy. Electrophoresis, however, is not sensitive enough. For this reason, at the second stage of the examination, a more sensitive test is recommended – urine protein immunofixation. This avoids diagnostic errors, given that gammopathy may have a normal protein electrophoresis result. The immunofixation method allows not only to detect even a small amount of free light chains, but also to determine their class (lambda or kappa chains).

As a rule, a parallel analysis of both blood and urine is performed. This is due to some features of the excretion of light chains in gammopathy. For example, most patients with clinical signs of myeloma have more than 3 g of M-protein per dl of blood on serum electrophoresis. However, approximately 20% of patients have only a slight increase in M-protein (less than 1 g per dl of blood) or even a normal level of blood immunoglobulins. Urinalysis of these patients can detect increased excretion of light chains in the urine (this myeloma is often called Bence-Jones myeloma). Thus, parallel analysis helps prevent diagnostic errors.

It should be noted that there is a special, rare form of myeloma in which light chains are not detected either in the blood or in the urine, either by electrophoresis or by immunofixation (the so-called non-secreting multiple myeloma). To diagnose this form of myeloma, it is recommended to determine the ratio of free light chains of immunoglobulins λ and κ in blood serum.

Bence-Jones protein may also not be detected in urine early in the disease when excess free light chains can still be reabsorbed in the renal tubules (up to 1 g per day with normal kidney function), and in rare cases when free lungs chains form tetramers that are not filtered in the renal glomerulus.

False-positive results may occur with certain drugs (eg, high-dose aspirin and penicillin), chronic renal failure, or certain systemic diseases (rheumatoid arthritis, SLE, polymyositis).

Given these limitations of the immunofixation method, the interpretation of the results should be carried out taking into account additional anamnestic, laboratory and instrumental data.

What is research used for?

• For the diagnosis and treatment of monoclonal gammopathy (multiple myeloma, light chain disease, Waldenström’s macroglobulinemia).

When is the test scheduled?

• If you suspect multiple myeloma and other diseases from the group of monoclonal gammopathy (multiple myeloma, light chain disease, Waldenström’s macroglobulinemia).

What do the results mean?

Reference values ​​

Result: not found.

Paraprotein represented by kappa/lambda light chains was not found.

Positive:

• primary amyloidosis;
• monoclonal gammopathy of unknown origin;
• cryoglobulinemia;
• Fanconi syndrome;
• hyperparathyroidism;
• multiple myeloma;
• osteomalacia;
• Waldenström’s macroglobulinemia;
• medullary thyroid cancer;
• adenocarcinoma of the pancreas;
• lymphoma;
• leukemia;
• Bence-Jones idiopathic proteinuria.

Negative:

• normal;
• effective treatment of the disease.

What can influence the result?

• Disease stage: Bence-Jones protein may not be detectable in urine early in the disease;
• high doses of aspirin and penicillin may result in a false positive;
• the presence of systemic diseases (rheumatoid arthritis, systemic lupus erythematosus, polymyositis) and chronic renal failure may lead to a false positive result;
• The presence of lambda or kappa light chain tetramers (not excreted in urine) may result in a false negative result.

Important notes

• Immunofixation of both urine and blood proteins is recommended;
• interpretation of the results should be carried out taking into account additional anamnestic, laboratory and instrumental data.

Also recommended

[06-004] Serum albumin

[06-035] Serum total protein

[06-038] Urine total protein

[08 -010] Total immunoglobulins G (IgG ) in serum

[08-011] Total immunoglobulins M (IgM) in serum

[06-011] Protein fractions in serum

[13-056] Immunofixation of blood serum immunoglobulins with antisera IgG, A, M K, L with quantitative determination of paraprotein

Who orders the examination?

Hematologist, oncologist, internist, general practitioner.