An alpha-1 flat curve on electrophoresis is associated with which condition?

• A. Juvenile Cirrhosis
• B. Pulmonary Emphysema
• C. Hypogammaglobulinemia
• D. Multiple Myeloma

Answer: (A)

A flat or reduced alpha-1 region on serum protein electrophoresis points to low levels of alpha-1 antitrypsin, a protease inhibitor made by the liver that normally resides in the alpha-1 globulin fraction. When this inhibitor is deficient, unchecked neutrophil elastase damages elastic tissue in the lungs, leading to early onset panacinar pulmonary emphysema. So, the association you’d expect with a flattened alpha-1 band is emphysema due to alpha-1 antitrypsin deficiency. (Alpha-1 antitrypsin deficiency can affect the liver as well, but the characteristic link on electrophoresis is emphysema.)