Evidence of end-organ damage as defined by the CRAB criteria. 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. 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. Skeletal lesions (e.g., lytic lesions, diffuse osteopenia, vertebral compression fractures) are present in 80 percent of patients. MGUS is usually detected by chance when you have a blood test for another condition. When the body produces abnormal antibodies, they are called monoclonal proteins, or M proteins. In some patients, the myeloma cells do not make a complete monoclonal immunoglobulin molecule with two heavy and two light chains. Typically, the monoclonal protein is discovered, and workup then ensues. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Monoclonal gammopathy is present in up to 8 percent of healthy geriatric patients.12 All patients with monoclonal gammopathy require further evaluation to determine the cause of the abnormality. See additional information. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process, and they usually are associated with nonmalignant conditions. Bone marrow testing involves two steps usually done at the same time in a doctor's office or a hospital: The diagnosis of myeloma depends on three main findings: Revised International Myeloma Working Group (IMWG) Criteria for the Diagnosis of Multiple Myeloma. Available from: National Multiple Sclerosis Society [Internet]. Cawley LP, Minard BJ, Tourtellotte WW, et al. What specimens can be used to perform an immunofixation test? Copyright 2017, 2013 Decision Support in Medicine, LLC. Platelets Small substances in your blood that help the blood to form a thickened mass (or blood clot) to help stop bleeding. Urine immunofixation uses electricity to push proteins from your urine sample through a kind of gel. The remainder had hypogammaglobulinemia or a normal-appearing pattern. If there are not CRAB signs and/or symptoms, 60% plasma cells in the bone marrow indicates a diagnosis. 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. Endoscopy vs. Colonoscopy: How Do They Differ? Alexandria (VA): American Society of Clinical Oncology; 20052019. Among 161 patients in whom both serum and urine demonstrated positive results for monoclonal protein and who were, posttreatment, negative for serum immunofixation, just 3 (1.9%) displayed positive urine immunofixation. Some immunoglobulins can be abnormal and may be due to cancer. Available from: Maine Health [Internet]. Albumin, the major protein component of serum, is produced by the liver under normal physiologic conditions. Am J Clin Pathol. Washington D.C.: American Association for Clinical Chemistry; c20012019. 2018 Sep 7. There are a number of reasons why a doctor may order this test. Proteins play many important roles, including providing energy for the body, rebuilding muscles, and supporting the immune system. No monoclonal protein detected M-PROTEIN ISOTYPE MALDI-TOF MS FLAG Negative Interpretation Monoclonal Gammopathies: -A characteristic monoclonal band (M-spike) is often found on serum protein electrophoresis (SPE) in the gamma globulin region and, more rarely, in the beta or alpha-2 regions. Although this spike is usually greater than 3 g per dL in patients with multiple myeloma, up to one fifth of patients with this tumor may have an M-protein spike of less than 1 g per dL.10 Hypogammaglobulinemia on serum protein electrophoresis occurs in about 10 percent of patients with multiple myeloma who do not have a serum M-protein spike.11 Most of these patients have a large amount of Bence Jones protein (monoclonal free kappa or lambda chain) in their urine.11 Thus, the size of the M-protein spike is not helpful in excluding multiple myeloma. Thus, it is most often present in the blood but not in the urine. 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. Detection of oligoclonal bands in cerebrospinal fluid by immunofixation electrophoresis. Immunoglobulins are proteins that function as antibodies, which fight infection. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. If a monoclonal protein is present, a precipitant will form at this phase. Fanning SR, Hussein MA. The protein electrophoresis test is often used to find abnormal substances called M proteins. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. On the left a serum protein electrophoresis (SPEP) of a patient with a monoclonal band in the gamma region is shown. IgA or IgM bands are less common. M-protein level is usually greater than 3 g per dL. Ceruloplasmin, alpha2-macroglobulin, and haptoglobin contribute to the alpha2-protein band. [9]. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. On the contrary, a persistent monoclonal protein despite treatment is a sign of refractory disease. During the fixation phase, antiserum containing anti-IgG, anti-IgA, anti-IgM, anti-light chain kappa, or anti-light chain lambda is inoculated with the serum proteins. Here are my blood test results for "Interpretation" part. https://www.uptodate.com/contents/search. Available from: Lab Tests Online [Internet]. A second screen is used to confirm positive test results. However, you shouldnt have a lot of protein in your urine. [Full Text]. Serum protein electrophoresis is used to identify patients with multiple myeloma and other serum protein disorders. In the interpretation of serum protein electrophoresis, most attention focuses on the gamma region, which is composed predominantly of antibodies of the IgG type. This means that high or low levels of the five protein types examined during the test can point to different illnesses. Typically present in low amounts, conditions such as multiple myeloma and Waldenstrms macroglobulinemia show proliferation of abnormal or cancerous plasma cells. Leukemia. URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. Exp Ther Med. The peaks for these components lie toward the negative electrode, with the gamma peak being closest to that electrode. [13, 14], Diagnosis of plasma cell dyscrasias All rights reserved. Any one or more of the following myeloma-defining events: Evidence of end-organ damage that can be attributed to the disease: (CRAB criteria), Clonal plasma cells in the bone marrow 60% with or without CRAB, Ratio of involved/uninvolved serum free light chain ratio 100 (involved free light chain levels must be 100mg/L), One or more focal lesions found on MRI studies (at least 5 mm in size), Bone/skeletal survey (x-rays of all the bones in the body), Whole body low-dose computed tomography (CT) scan, Positron emission tomography and computed tomography (PET-CT) scan, Download or order The Leukemia & Lymphoma Society's free booklets. In other cases, patients may have non-specific symptoms, meaning the discovery of a protein band in the serum . John C Leighton, Jr, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Hematology, American Society of Clinical OncologyDisclosure: Nothing to disclose. National Multiple Sclerosis Society; MS Symptoms; [cited 2019 Dec 18]; [about 3 screens]. Next-generation sequencing is being done now on a research basis but may soon be used in routine clinical practice. These proteins can also be referred to as an M-spike, monoclonal immunoglobulin, or paraprotein. The most common type of myeloma is IgG kappa, occurring in approximately 52 % of patients. Follow our channels and share your own adventure. Inflammatory diseases include. 25th ed. Kaplan JS, Horowitz GL. 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. Myelomacells produce many copies of its anibody. Your doctor may also order more tests. Malignant plasma cells in the bone marrow 10% or presence of bony or extramedullary plasmacytoma, confirmed by biopsy. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019. Beta1 is composed mostly of transferrin, and beta2 contains beta-lipoprotein. Ronald Hoffman, Leslie E. Silberstein, Sanford J. Shattil, Bruce Furie, Philip McGlave. An accurate diagnosis is one of the most important aspects of a persons medical care. The identification of a monoclonal immunoglobulin is helpful in the diagnosis of the following conditions What is the clinical application of an immunofixation test? 5th. The IFX test can also be used to study changes in the structure of normal. [20]. It may also depend on the unique patterns made by the proteins. The test may also be performed again in the future. Visual examination of electrophoretic patterns by a pathologist is the most sensitive method of detecting monoclonal proteins since small bands may be obscured in densitometric scans. Monoclonal gammopathy of undetermined significance (MGUS). In blood cancers such as myeloma, the 'M' in 'M protein' stands for monoclonal. A homogeneous spike-like peak in a focal region of the gamma-globulin zone indicates a monoclonal gammopathy. [Full Text]. Common causes of high levels include: Low protein levels may be caused by many conditions. This causes the different types of proteins to move and group together. Bone Marrow Tests. A monoclonal spike (M spike or paraprotein) on serum protein electrophoresis (SPEP) is a frequent finding in the general population and typically is pathognomonic of an asymptomatic, premalignant condition called monoclonal gammopathy of undetermined significance (MGUS). This is a normal serum protein electrophoresis (SPE) pattern; also listed are a few of the proteins associated with each fraction. Protein electrophoresis alone is not considered an adequate screen for monoclonal gammopathies. Clinical course and management of monoclonal gammopathy of undetermined significance. Available from. How is a urine sample collected for an immunofixation test? An immunofixation blood test, also known as protein electrophoresis, measures certain proteins in the blood. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: leukemia; [cited 2019 Dec 10]; [about 3 screens]. Some people may experience a rash or nerve problems, such as numbness or tingling. Sign-upto receive the latest news on BCIT. Immune Thrombocytopenia Purpura (ITP): What helps? 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. Your doctor tests your bone marrow to look for malignant plasma cells. In many myeloma patients, the coordinated process of making and attaching light chains and heavy chains fails in the malignant plasma cells. The method can be used to examine specific proteins in the blood, urine, and other body fluids. Healthline Media does not provide medical advice, diagnosis, or treatment. 2011. All of these measurements provide information about the extent of the disease and are useful for monitoring response to treatment. One pathologic reason which we covered at BCIT is a monoclonal gammopathy. The Leukemia & Lymphoma Society is a 501(c)(3) organization, and all monetary donations are tax deductible to the fullest extent allowed by tax laws. Monoclonal protein is the output of myeloma cells in most people with myeloma. Its a useful skill to maintain, as technologists especially those on off-shifts or at smaller sites may still collect through their career(s). Urine IFE tests are often done if IFE blood test results were not normal. Given the dismal impact on prognosis in the latter scenario, It can also can vary in how that amount relates to the behavior of the myeloma. Mass spectrometry for the evaluation of monoclonal proteins in multiple myeloma and related disorders: an International Myeloma Working Group Mass Spectrometry Committee Report. The output of monoclonal protein can vary from patient to patient. Less than 10% plasma cells are present in bone marrow, and patients have no lytic bony lesions, anemia, hypercalcemia, or renal insufficiency. Electrophoresis separates proteins based on their physical properties, and the subsets of these proteins are used in interpreting the results. Instead, they only make light chains. (2015, August 12), Serum protein electrophoresis. [16]. Please check with your financial advisor if you have more questions. High amounts of M protein in a person's blood or urine may be a sign they have multiple myeloma but the presence of M proteins could also indicate other types of plasma cell tumors. Synonym (s): paraprotein (2) . Learn why immunohistochemistry is the gold standard in testing for certain diseases, including several cancers. Immunoglobulin-related amyloidosis. There are two types of light chains, referred to as kappa (k) and lambda ().. Serum Protein Electrophoresis (SPEP) Test; [cited 2021 Aug 9]; [about 3 screens]. Immunoglobulins are secreted by plasma cells, a type of white blood cell in the bone marrow, in response to infection and disease. Browse the 32 health-related programs and part-time courses available at BCITs School of Health Sciences. This test is most often used to help diagnose or monitor a variety of different conditions. The "M" technically stands for "monoclonal," but M protein is often referred to as myeloma protein. Evol Med Public Health. The band pattern is specific for certain diseases. Copyright 2023 Haymarket Media, Inc. All Rights Reserved 2015 May. StatPearls. 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. [10], Primary screening for plasma cell dyscrasias, No studies have addressed the role of serum or urine immunofixation in screening of the general population for multiple myeloma and related disorders. This is serum. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. Many subspecialists. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). [Full Text]. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Monoclonal gammopathies of undetermined significance. If all tests are normal, the pattern of follow-up in Figure 36 can be undertaken. Home Decision Support in Medicine LabMed, Monoclonal gammopathy of unknown significance (MGUS), Low concentration of monoclonal immunoglobulins (LCMI). Posts: 33. Medscape Drugs & Diseases. A total protein test can determine whether you have high blood protein. Electrophoresis is not usually used by itself to diagnose a disease. The five groups of proteins usually considered during an SPEP test are: Electrophoresis is a lab technique used to separate groups of proteins in blood serum. This is a broad term encompassing a number of modern technologies that increase the speed and reduce the cost of DNA sequencing to look for mutations. Cytogenetic Analysis. what does no apparent monoclonal protein on serum electrophoresis mean. A serum thyroxine-binding globulin (TBG) level test is a blood test that measures the amount of TBG in your blood. Definition. How is a serum sample collected for an immunofixation test? If present, an excessive production of a monoclonal immunoglobulin may be shown in laboratory test results as a spike on a graph (M spike). The procedure was nearly identical to one of our labs at BCIT, so Im glad to have had a bit of experience in preparing the gel and dispensing the antisera. 2023 Healthline Media LLC. 95:2126-33. Abnormalities in any of these tests should result in a referral to a hematologist-oncologist. Other inflammatory conditions of the CNS can present with oligoclonal bands in CSF resulting from intrathecal production of antibodies. Blood appears to be a single substance to the naked eye. Multiple Myeloma: Symptoms and Signs; 2016 Oct [cited 2019 Dec 10]; [about 3 screens]. Available from: Straub RH, Schradin C. Chronic inflammatory systemic diseases: An evolutionary trade-off between acutely beneficial but chronically harmful programs. The alpha2 component is increased as an acute-phase reactant. Definitive diagnosis of multiple myeloma requires 10 to 15 percent plasma cell involvement as determined by bone marrow biopsy. In: Goldman-Cecil Medicine. Affected patients have hyperviscosity and hypercellular bone marrow with extensive infiltration by lymphoplasma cells. Other more-specific tests, including serum protein electrophoresis (SPEP), can help determine the exact source, such as liver or bone marrow. Under the PE Value it says: "SPE1". These conditions should be promptly diagnosed and treated. If the result is negative, it is safe to conclude that a pure kappa or lambda light chain is present. 11 (2):24. Monoclonal gammopathy of undetermined significance (MGUS) care at Mayo Clinic. Sometimes, however, the results of this examination can be confusing or difficult to interpret. [QxMD MEDLINE Link]. Monoclonal bands are usually seen in the zone but may be seen in proximity of the band or, rarely, in the 2 region. Role of urine immunofixation in the complete response assessment of MM patients other than light-chain-only disease. People with monoclonal gammopathy generally don't experience signs or symptoms. Diagnosis is often done with a lab test called electrophoresis. There is greater than 10 percent plasma cell involvement on bone marrow biopsy. Thanks for helping me with this quality post. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Making sense of serum protein bands. These so-called monoclonal gammopathies constitute a group of disorders that are characterized by proliferation of a single clone of plasma cells that produce a homogeneous M protein.6, It is extremely important to differentiate monoclonal from polyclonal gammopathies. There are several reasons a patients SPE curve could be abnormal. Close more info about Monoclonal Protein on Serum Protein Electrophoresis (M Component), Metabolic Alkalosis: Arterial Blood pH Elevated with Increased Arterial pCO2. Surveillance for multiple myeloma in patients with MGUS and favorable prognostic factors (ie, low levels of monoclonal protein and IgG type) should include monitoring at 6 months and then every 2-3 years thereafter. All rights reserved. Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. Medscape Drugs & Diseases. [Full Text]. 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. Portland (ME): Maine Health; c2019. ), New-onset anemia associated with renal failure or insufficiency and bone pain, Back pain in which multiple myeloma is suspected, Hypercalcemia attributed to possible malignancy (e.g., associated weight loss, fatigue, bone pain, abnormal bleeding), Rouleaux formations noted on peripheral blood smear, Renal insufficiency with associated serum protein elevation, Unexplained pathologic fracture or lytic lesion identified on radiograph, Viral infections, especially hepatitis, human immunodeficiency virus infection, mononucleosis, and varicella, M protein appears as a narrow spike in the gamma, beta, or alpha. Bone marrow examination may be informative. My first week back in Chem was spent on the electrophoresis bench. The subgroups are: Measuring the proteins in each subgroup can help diagnose a variety of diseases. The M protein has an incomplete heavy chain and no light chain. The test separates these proteins into subgroups based on their size and electrical charge. It's easier to check your kidney health at home now more than ever. This abnormal protein is formed within your bone marrow, the soft, blood-producing tissue that fills in the center of most of your bones. Malnutrition; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. Protein electrophoresis immunofixation electrophoresis. https://www.uptodate.com/contents/search. Available from: Lab Tests Online [Internet]. The pattern of serum protein electrophoresis results depends on the fractions of two major types of protein: albumin and globulins. Characterized by a sharp peak in the beta-gamma region, monoclonal gammopathies involve increased production of immunoglobulins, or antibodies (IgA, IgG, IgM, etc.). Among these other causes are Waldenstrms macroglobulinemia, solitary plasmacytoma, smoldering multiple myeloma, monoclonal gammopathy of undetermined significance, plasma cell leukemia, heavy chain disease, and amyloidosis.4,7, The quantity of M protein can help differentiate multiple myeloma from monoclonal gammopathy of undetermined significance. Malignancy and acute inflammation (resulting from acute-phase reactants) can increase the alpha1-protein band. When is an immunofixation test indicated? Immunofixation reveals the heavy chain as alpha, gamma, or mu. Continuing Medical Education (CME/CE) Courses.
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