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1376 Proteins Induced by Vitamin K Absence or Antagonism (PIVKA)

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Fraction Rel % G/dL Fraction Rel % G/dL Fraction Rel % G/dL
1 44.9 3.37 1 28.8 2.97 1 23.4 2.41
2 5.0 0.38 2 7.1 0.73 2 10.4 1.07
3 11.5 0.86 3 20.1 2.07 3 7.7 0.79
4 10.4 0.78 4 7.5 0.77 4 3.2 0.33
5 7.6 0.57 5 6.4 0.66 5 7.0 0.72
6 20.6 1.55 6 30.1 3.10 6 6.7 0.69
7 41.7 4.30
Total G/dL 7.50 A/G: 0.81 Total G/dL 10.30 A/G: 0.40 Total G/dL 10.30 A/G: 0.31
Comments: Comments: Comments:
PROTEIN ELECTROPHORESIS, NORMAL Serum PROTEIN ELECTROPHORESIS, POLYCLONAL PROTEIN ELECTROPHORESIS, MONOCLONAL
protein electrophoresis tracing demonstrating a normal Serum protein electrophoresis tracing demonstrating Serum protein electrophoresis tracing demonstrating
distribution of serum proteins. hyperglobulinemia that is polyclonal in distribution, hyperglobulinemia that is monoclonal in distribution
as is typical of inflammation. (single peak). This patient had multiple myeloma.

Causes of Abnormally High Levels peritonitis, leishmaniasis, feline stomatitis, Lab Artifacts
• Increased alpha globulin: acute inflamma- lymphoplasmacytic enterocolitis) Hemolysis artificially elevates beta globulins,
tion, nephrotic syndrome, corticosteroid because hemoglobin migrates in this region on
administration Causes of Abnormally Low Levels electrophoresis; lipemia promotes hemolysis.
• Increased beta globulin: acute inflammation, • Albumin: acute-phase response, glomerular
nephrotic syndrome, liver disease, immune disease, liver disease, starvation, cachexia Specimen Collection and Handling
responses, neoplasia • Albumin and globulins: gastrointestinal Serum (red top tube), refrigerate. Heparinized
• Increased gamma globulins: immune stimula- disease (protein-losing enteropathy), blood plasma (green top tube) is acceptable.
tion, neoplasia loss, sequestration in body cavity effusion,
severe exudative skin disease, excess fluid Relative Cost: $$
Next Diagnostic Steps to Consider therapy or water intake
if Levels are High • Globulins: failure of passive transfer (FPT), Pearls
• Polyclonal gammopathy: assess for inflam- inherited or acquired immunodeficiency The numeric values obtained from protein
mation, infection, immune-mediated disease, electrophoresis must be assessed in conjunction
liver disease, neoplasia (neoplasia less com- Next Diagnostic Steps to Consider with the tracing. The values alone do not dif-
monly polyclonal) if Levels are Low ferentiate between monoclonal and polyclonal
• Monoclonal gammopathy: assess for Based on which fraction(s) is/are low, investigate gammopathies.
multiple myeloma, B-cell lymphoma, for albumin loss or decreased albumin synthesis,
lymphocytic leukemia; inflammatory or globulin loss, FPT, acquired or inherited AUTHOR: Ruanna E. Gossett, DVM, PhD, DACVP
EDITOR: Lois Roth-Johnson, DVM, PhD, DACVP
infectious disease (infection less commonly immunodeficiency
monoclonal; ehrlichiosis, feline infectious

Proteins Induced by Vitamin K Absence or Antagonism (PIVKA)

Definition inactive precursors in the liver, they require Causes of Abnormally High Levels
Proteins induced by vitamin K absence or antago- vitamin K for activation. Vitamin K epoxide Decreased vitamin K (e.g., neonate born to
nism (PIVKAs) are inactive precursor coagulation reductase is critical for this reaction. In the malnourished mother, prolonged anorexia),
proteins that accumulate in the peripheral blood absence of vitamin K or if vitamin K epoxide malabsorption of vitamin K (e.g., cholestasis,
when vitamin K is absent or inhibited. reductase is inhibited (e.g., by anticoagulant infiltrative bowel disease), or vitamin K
rodenticides), the inactive coagulation precur- antagonism (e.g., anticoagulant rodenticides,
Synonym sors (PIVKAs) accumulate in the blood. The therapeutic Coumadin)
Thrombotest thrombotest, which is actually a modification
of the prothrombin test, is sensitive to PIVKAs Next Diagnostic Steps to Consider
Physiology but does not directly measure them. if Levels are High
Factors II, VII, IX, X, and proteins C, S, and Z CBC/profile, urinalysis (avoid cystocentesis),
are all vitamin K–dependent proteins involved Reference Interval coagulation profile, determine if recent exposure
in coagulation homeostasis. Synthesized as Dogs: 12-20 seconds; cats: 20-30 seconds to drugs or anticoagulant rodenticides. Draw

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