what does no apparent monoclonal protein on serum electrophoresis mean what does no apparent monoclonal protein on serum electrophoresis mean

The presence of M proteins can be a sign of a type of cancer called myeloma, or multiple myeloma. URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. High protein levels may be caused by many conditions. A monoclonal protein is produced by the abnormal, cancerous or precancerous cells. correct number of peaks and protein values), the analyzer does a pretty good job of identifying each fraction. This is serum. It can also detect changes in the ratio of kappa and lambda light chain production, which indicates an excess of abnormal plasma cells. Both of the following criteria must be met: In healthy individuals, plasma cellsproduce proteins called polyclonal immunoglobulins. These are a collection of antibodies that protect the body against all kinds of different invading viruses, bacteria or other infectious agents (antigens). These include an elevated protein level, anemia and abnormalities in kidney function or calcium levels. Most patients with untreated myeloma have a monoclonal immunoglobulin spike in serum, urine, or both. Monoclonal antibodies could be used as myeloma treatments and can be identified by serum protein electrophoresis and immunofixation electrophoresis. Heavy/light chain specific immunoglobulin ratios provides no additional information than serum proteins electrophoresis and immunofixation for the diagnosis and the follow-up of intact immunoglobulin multiple myeloma patients. Protein Electrophoresis, Immunofixation Electrophoresis; [updated 2019 Oct 25; cited 2019 Dec 10]; [about 2 screens]. [16]. A homogeneous spike-like peak in a focal region of the gamma-globulin zone indicates a monoclonal gammopathy. Keep in mind that these are just clues. There is less than 10 percent plasma cell involvement on bone marrow biopsy. 2015 Oct. 47 (6):564-9. Under the PE Value it says: "SPE1". Alpha-1 Antitrypsin; [updated 2019 Nov 13; cited 2019 Dec 10]; [about 2 screens]. CSF immunofixation that does not reveal oligoclonal bands is also considered normal. Protein electrophoresis alone is not considered an adequate screen for monoclonal gammopathies. When might mass spectrometry be used in place of immunofixation? M-protein level is usually greater than 3 g per dL. This content is owned by the AAFP. If the monoclonal protein level decreases or is undetectable after chemotherapy, it might indicate a response to treatment. A normal result includes a darker immunoglobulin G (IgG) lane, a lighter immunoglobulin A (IgA), an absent immunoglobulin M (IgM), and a denser kappa compared to lambda lane, with ratio of 2:1. Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel. Therefore, such an approach cannot be currently recommended. If these examinations are normal, serum protein electrophoresis should be repeated in three to six months; if that examination is normal, serum protein electrophoresis should be repeated annually. Moving toward the negative portion of the gel (i.e., the negative electrode), the next peaks involve the alpha1 and alpha2 components. Cawley LP, Minard BJ, Tourtellotte WW, et al. IFE classifies the monoclonal based on the type of heavy (IgG, IgA or IgM) and light (kappa or lambda) chains that make up the antibodies. Portland (ME): Maine Health; c2019. Tests are done to measure the levels of many different substances in the blood. Available from: National Heart, Lung, and Blood Institute [Internet]. Available from: Systemic Autoinflammatory Disease (SAID) Support [Internet]. Making sense of serum protein bands. Some. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. When excreted in large amounts, Bence Jones proteins (free light chains) can sometimes make the urine appear foamy and they can cause injury to the kidneys. Urine IFE tests are often done if IFE blood test results were not normal. 25th ed. 109:585-8. [Internet]. Sometimes a CBC with differential (CBC with diff), a test that also measures the number of the different types of white blood cells present in the blood, is ordered. Following my rotation in Anatomical Pathology, I spent one week on accessioning review and another three in Chemistry. Other inflammatory conditions of the CNS can present with oligoclonal bands in CSF resulting from intrathecal production of antibodies. A polyclonal gammopathy is characterized by a broad diffuse band with one or more heavy chains and kappa and lambda light chains.7, Once a monoclonal gammopathy is identified by serum protein electrophoresis, multiple myeloma must be differentiated from other causes of this type of gammopathy. The quantity of M protein, the results of bone marrow biopsy, and other characteristics can help differentiate multiple myeloma from the other causes of monoclonal gammopathy. The alpha2 component is increased as an acute-phase reactant. The beta fraction has two peaks labeled beta1 and beta2. The most common type of myeloma is IgG kappa, occurring in approximately 52 % of patients. Washington D.C.: American Association for Clinical Chemistry; c20012019. The Leukemia & Lymphoma Society (LLS) is a global leader in the fight against blood cancer. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. Inflammatory diseases include. [ 1] Serum or urine immunofixation negative for a monoclonal protein or a polyclonal pattern is. Platelets Small substances in your blood that help the blood to form a thickened mass (or blood clot) to help stop bleeding. Connect with others like you for support and answers to your questions in the Blood Cancers & Disorders support group on Mayo Clinic Connect, a patient community. Malnutrition; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. Medscape Drugs & Diseases. Anastasios Dimou, MD Resident Physician, Department of Internal Medicine, Albert Einstein Medical CenterDisclosure: Nothing to disclose. 22:1262-8. Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. In zone electrophoresis, for example, different protein subtypes are placed in separate physical locations on a gel made from agar, cellulose, or other plant material.2,3 The proteins are stained, and their densities are calculated electronically to provide graphical data on the absolute and relative amounts of the various proteins. Obtaining a precise diagnosis will help the doctor to: The results of blood tests that accompany periodic medical examinations may indicate the need for further evaluation for myeloma. Available from: National Cancer Institute [Internet]. When there is damage to the kidneys, other proteins, such as albumin, may also be present in the urine. That criteria is determined by a pathologist who reviews the bone marrow aspirate slides. Myeloma affects white blood cells called plasma cells in the bone marrow. Eric B Staros, MD Associate Professor of Pathology, St Louis University School of Medicine; Director of Clinical Laboratories, Director of Cytopathology, Department of Pathology, St Louis University Hospital Philadelphia, PA, USA: Elsevier Churchill Livingstone; 2008. chapter 87. 2019 Jan. [QxMD MEDLINE Link]. Monoclonal gammopathies of undetermined significance. Please confirm that you would like to log out of Medscape. M-protein level is greater than 3 g per dL. You can also contact us directly if you need to. Technique: Collection starts early in the morning after the first morning urine has been voided and continues for the subsequent 24 hours, including the first morning urine of the following day. [9], Surveillance among patients with MGUS or smoldering (asymptomatic) multiple myeloma, Immunofixation of the urine and serum should be included in a battery of tests after 2-3 months following diagnosis of smoldering myeloma, then every 4-6 months for 1 year, and, finally, every 6-12 months if the results are stable. Urine immunofixation uses electricity to push proteins from your urine sample through a kind of gel. The most common condition linked with these abnormal proteins is MGUS. Common causes of low levels include: Your diagnosis will depend on which specific protein levels were not normal, and whether the levels were too high or too low. If the serum M-protein spike is 1.5 to 2.5 g per dL, it is important to perform nephelometry to quantify the immunoglobulins present and to obtain a 24-hour urine collection for electrophoresis and immunofixation. Affected patients have no lytic bone lesions, no anemia, no hypercalcemia, and no renal disease. Kidney or liver disease, a condition involving inflammation, poor nutrition, Disease leading to inflammation (condition may be chronic or acute), Liver disease, congenital emphysema (rare), Kidney disease, disease leading to inflammation (condition may be chronic or acute), Liver disease, poor nutrition, breakdown of red blood cells, Anemia, multiple myeloma, high cholesterol, Rheumatoid arthritis, infection, liver cirrhosis, inflammatory disease, multiple myeloma, lymphoma. [Full Text]. A small number of patients with myeloma have either oligosecretory disease, inwhich the detectable level of monoclonal protein is low, or nonsecretory disease,in which no monoclonal protein can be detected. In Kelowna I had the week of review, and go out 2-3 mornings a week while in Chem and Hematology. M protein is made by abnormal plasma cells. Yang G, Geng C, Chen W. Clinical characteristics of a group of patients with multiple myeloma who had two different light chains by immunofixation electrophoresis: A retrospective study from a single center. How is a serum sample collected for an immunofixation test? Much of the clinical interest is focused on the gamma region of the serum protein spectrum because immunoglobulins migrate to this region. National Multiple Sclerosis Society; MS Symptoms; [cited 2019 Dec 18]; [about 3 screens]. Albumin, the major protein component of serum, is produced by the liver under normal physiologic conditions. Rajhumar SV. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. What does "polyclonal light chains detected but no monoclonal immunoglobilin or free light chain (bencejones) is MD presence of free light chain in urine is diagnostic of multiple myeloma.Multiple myeloma is a type of cancer that is caused by malignant plasma cells that proliferate in the bone marrow and produce abnormally high amounts. An M-protein spike of greater than 2.5 g per dL should be assessed with a metastatic bone survey that includes a single view of the humeri and femurs. Typically present in low amounts, conditions such as multiple myeloma and Waldenstrms macroglobulinemia show proliferation of abnormal or cancerous plasma cells. The IFX test can also be used to study changes in the structure of normal. The test may also be performed again in the future. There is very little risk to having a blood test. Accessed April 18, 2019. A second screen is used to confirm positive test results. Immunofixation "fixes" certain proteins into place with antibodies and then washes away the others before staining them. The alpha1-protein fraction is comprised of alpha1-antitrypsin, thyroid-binding globulin, and transcortin. [Full Text]. Serum protein bands (monoclonal gammopathy) will sometimes be found following serum protein electrophoresis in patients presenting with classic signs or symptoms of multiple myeloma, e.g. Anemia, pancytopenia, hypercalcemia, and renal disease may be present. Hematology: Basic Principles and Practice. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Monoclonal gammopathy of undetermined significance (MGUS). Madison (WI):University of Wisconsin Hospitals and Clinics Authority; c2021. Collection in a container: A plastic collection container is used. Copyright 2023 Haymarket Media, Inc. All Rights Reserved However, the presence of oligoclonal bands does not necessarily confirm the diagnosis, as other conditions can present with oligoclonal bands in the CSF. This article provides a comprehensive review of serum protein electrophoresis, including a discussion of how the examination is performed, what it measures, and when it is indicated. 2009. 2010. Immunofixation is clearly indicated upon clinical or laboratory evidence of a plasma cell dyscrasia for the diagnosis of multiple myeloma, Waldenstrom macroglobulinemia, or amyloid light-chain (AL) amyloidosis. The disorder occurs most commonly in older men. Bone marrow biopsy may be useful to show aggregates of plasma cells in focal or diffuse patterns. Goldman L, et al., eds. When screening a patient or establishing a first-time diagnosis for a monoclonal gammopathy, consider ordering DMOGA / Monoclonal Gammopathy, Diagnostic, Serum instead, which includes free light chain analysis. This test measures the numbers of red blood cells, white blood cells and platelets in the blood. If the result is negative, it is safe to conclude that a pure kappa or lambda light chain is present. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant, including multiple myeloma, Waldenstrms macroglobulinemia, solitary plasmacytoma, smoldering multiple myeloma, monoclonal gammopathy of undetermined significance, plasma cell leukemia, heavy chain disease, and amyloidosis. The albumin band represents the largest protein component of human serum. A negative urine or serum immunofixation result does not always rule out a plasma cell dyscrasia, as a nonsecretory or oligosecretory multiple myeloma can present with a negative immunofixation finding in both the urine and the serum. Exp Ther Med. The precise cause of MGUS isn't known. This allows them to be measured and analyzed individually. It involves exposing serum placed in a. [QxMD MEDLINE Link]. Peripheral blood smear often shows RBC aggregates in a rouleaux formation. To view unlimited content, log in or register for free. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019. Health Encyclopedia: Immunofixation (Blood); [cited 2019 Dec 10]; [about 2 screens]. In addition, a beta2 microglobulin test, a CRP test, and a 24-hour urine collection for electrophoresis and immunofixation should be performed. Monoclonal bands are usually seen in the zone but may be seen in proximity of the band or, rarely, in the 2 region. Protein Electrophoresis questions. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. For patients with MGUS and high risk for progression to multiple myeloma, surveillance should be performed at 6 months and then yearly thereafter. In some patients, the myeloma cells do not make a complete monoclonal immunoglobulin molecule with two heavy and two light chains. Medscape Drugs & Diseases. Myeloma is a cancer of plasma cells, a type of white blood cell (WBC) in the bone marrow that is responsible for making immunoglobulins. This means that high or low levels of the five protein types examined during the test can point to different illnesses. Reference Range Immunofixation consists of an electrophoresis phase and a fixation phase. 1998. [Full Text]. M-protein is an antibodyor part of an antibodythat can show up in tests of your blood and/or urine, and its presence can mean different things. Accessed April 18, 2019. A total protein test can determine whether you have high blood protein. One of the best ways to get a better sense of the SPEP test is to look at each word in the name: Serum is the liquid part of your blood. Flow Cytometry. The gamma-globulin zone is decreased in hypogammaglobulinemia and agammaglobulinemia. Finally, when several bands with sharp borders are seen after immunofixation in cerebrospinal fluid (CSF) but not in serum, the result is reported as positive for oligoclonal bands. These symptoms could include the following: Some of the conditions that could be causing these symptoms are: No preparation is needed for the test. Its not always obvious what high or low protein levels in the blood serum may mean. Seiter K, Ponce D. Waldenstrom macroglobulinemia. Suspected multiple myeloma, Waldenstrms macroglobulinemia, primary amyloidosis, or related disorder, Unexplained peripheral neuropathy (not attributed to longstanding diabetes mellitus, toxin exposure, chemotherapy, etc. Common causes of high levels include: Low protein levels may be caused by many conditions. 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