what does no apparent monoclonal protein on serum electrophoresis meanst elizabeth family medicine residency utica, ny
In some patients, the myeloma cells do not make a complete monoclonal immunoglobulin molecule with two heavy and two light chains. There are two main types of proteins in the blood: albumin and globulin. In healthy individuals, antibodies produced by plasma cells in the bone marrow help this process. Serum is placed on a specific medium, and a charge is applied. Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, Association for Molecular Pathology, College of American PathologistsDisclosure: Nothing to disclose. How is a serum sample collected for an immunofixation test? This content does not have an Arabic version. Characteristic differentiating features of the monoclonal gammopathies are listed in Table 4.7, In some patients with a plasma cell dyscrasia, serum protein electrophoresis may be normal because the complete monoclonal immunoglobulin is absent or is present at a very low level.7 In one series,6 serum protein electrophoresis showed a spike or localized band in only 82 percent of patients with multiple myeloma. Immunofixation electrophoretic techniques applied to identification of proteins in serum and cerebrospinal fluid. You are being redirected to 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. 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). Seiter K, Ponce D. Waldenstrom macroglobulinemia. Blood appears to be a single substance to the naked eye. Monoclonal gammopathies of undetermined significance. Shah D, Seiter K. Multiple myeloma. Accessed April 18, 2019. Its a useful skill to maintain, as technologists especially those on off-shifts or at smaller sites may still collect through their career(s). Myeloma affects white blood cells called plasma cells in the bone marrow. Last medically reviewed on October 20, 2016, Proteins are found in the blood of healthy people. 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. Peaks and valleys in the bands may mean that you may be making too many or too few of certain proteins. 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. Mass spectrometry for the evaluation of monoclonal proteins in multiple myeloma and related disorders: an International Myeloma Working Group Mass Spectrometry Committee Report. Flow Cytometry. 1976. A malignant plasma cell is called a . The Leukemia & Lymphoma Society (LLS) is a global leader in the fight against blood cancer. Cawley LP, Minard BJ, Tourtellotte WW, et al. SPEP and UPEP don't measure myeloma cells; they measure the output of myeloma cells. An accurate diagnosis is one of the most important aspects of a persons medical care. Want to view more content from Cancer Therapy Advisor? Youve read {{metering-count}} of {{metering-total}} articles this month. Available from: Lab Tests Online [Internet]. There are five types of heavy chains, and each type is represented by a specific letter: IgG, IgA, IgD, IgE and IgM. San Francisco: Said Support; c2013-2016. Your doctor tests your bone marrow to look for malignant plasma cells. Rochester (NY): University of Rochester Medical Center; c2019. A second screen is used to confirm positive test results. The peaks for these components lie toward the negative electrode, with the gamma peak being closest to that electrode. Hematology: Basic Principles and Practice. Gainesville (FL): University of Florida Health; c2021. In Greek, the language of most medical terms, "myelo" refers to the blood-producing cells in the bone marrow, and "oma" refers to a tumor or mass of cancer cells. Bone Marrow Tests. National Multiple Sclerosis Society; MS Symptoms; [cited 2019 Dec 18]; [about 3 screens]. Am J Clin Pathol. The "M" technically stands for "monoclonal," but M protein is often referred to as myeloma protein. Because MGUS is not harmful, it doesn't need to be treated. Proteins are substances made of small chemicals called amino acids. 2011. Rarely, plasma cells can enter into the circulation and if they represent 20 percent or more of the blood cells, the condition is called plasma cell leukemia. Note that the percent of plasma cells in the bone marrow, assessed by flow cytometry, is not the value used in the diagnostic criteria above. 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. IgA or some other type). Protein Electrophoresis, Immunofixation Electrophoresis; [updated 2019 Oct 25; cited 2019 Dec 10]; [about 2 screens]. Plasma protein levels display reasonably predictable changes in response to acute inflammation, malignancy, trauma, necrosis, infarction, burns, and chemical injury. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. These tests are done in conjunction with immunofixation for example, serum immunofixation electrophoresis (SIFE), which identifies immunoglobulins in blood samples. The subsets of these proteins and their relative quantity are the primary focus of the interpretation of serum protein electrophoresis.1,3. Twenty-four-hour Bence-Jones protein determinations: can we ensure accuracy?. All rights reserved. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Exp Ther Med. The albumin band represents the largest protein component of human serum. 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. Medscape Drugs & Diseases. Detection of oligoclonal bands in cerebrospinal fluid by immunofixation electrophoresis. Protein electrophoresis serum : Overview; [updated 2021 Aug 9; cited 2021 Aug 9]; [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. Comparison of the Freelite serum free light chain (SFLC) assay with serum and urine electrophoresis/immunofixation and the N Latex FLC assay. https://www.uptodate.com/contents/search. 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. Diagnosis requires 10 to 15 percent plasma cell involvement on bone marrow biopsy. Quantitative determination of the serum M component to demonstrate that an IgG or IgM monoclonal protein is less than 3.0 g/dL or an IgA monoclonal protein is less than 2.0 g/dL, or that a Bence-Jones protein is less than or equal to 1.0 g in a 24-hour urine specimen. Continuing Medical Education (CME/CE) Courses. [13, 14], Diagnosis of plasma cell dyscrasias These include an elevated protein level, anemia and abnormalities in kidney function or calcium levels. Ronald Hoffman, Leslie E. Silberstein, Sanford J. Shattil, Bruce Furie, Philip McGlave. A small number of patients with myeloma have either "oligosecretory disease," in which the detectable level of monoclonal protein is low, or "nonsecretory disease," in which no monoclonal protein can be detected. Electrophoresis describes the migration of charged particles in an electric field, and their subsequent separation based on size and charge. Immunofixation can either reveal a normal pattern or identify a monoclonal protein or a polyclonal immunoglobulin pattern. Fanning SR, Hussein MA. Alexandria (VA): American Society of Clinical Oncology; 20052019. Blood. Tests are done to measure the levels of many different substances in the blood. When might mass spectrometry be used in place of immunofixation? 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 identification of a monoclonal immunoglobulin is helpful in the diagnosis of the following conditions The subgroups are: Measuring the proteins in each subgroup can help diagnose a variety of diseases. [20]. The released hemoglobin can also bind to haptoglobin, a protein in the 2 fraction, forming a hemoglobin-haptoglobin complex that blurs the 2 and separation and may resemble a malignant peak. All rights reserved. [QxMD MEDLINE Link]. Health Encyclopedia: Immunofixation (Blood); [cited 2019 Dec 10]; [about 2 screens]. Unattached, free light chains enter the blood and are excreted rapidly in the urine. Next-Generation Sequencing (NGS). The immunoelectrophoresis-serum test is used to. 2017 Dec 28. University of Rochester Medical Center [Internet]. 9 (5):1895-1900. 5 fractions are shown in this image: albumin, alpha-1 (1), alpha-2 (2), beta () and gamma (). 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. Hemoglobin is a substance in your red blood cells (blood cells that carry oxygen through your body) that carries oxygen from your lungs to the tissues in your body. A doctor may use the results to make a diagnosis or decide on a course of treatment. Are you a BCIT News insider? ), 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. Sign-upto receive the latest news on BCIT. Available from: Lab Tests Online [Internet]. ; 2014 Mar 14 [cited 2020 Jan 22]; [about 3 screens]. 2010. 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. laboratory tests, reference ranges, and understanding results, https://www.cancer.net/cancer-types/multiple-myeloma/diagnosis, https://www.cancer.net/cancer-types/multiple-myeloma/symptoms-and-signs, https://labtestsonline.org/tests/alpha-1-antitrypsin, https://labtestsonline.org/conditions/malabsorption, https://labtestsonline.org/conditions/malnutrition, https://labtestsonline.org/tests/protein-electrophoresis-immunofixation-electrophoresis, https://mainehealth.org/services/autoimmune-diseases-rheumatology/inflammatory-diseases, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/leukemia, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/lymphoma, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/multiple-myeloma, https://www.nhlbi.nih.gov/health-topics/blood-tests, https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753361, http://saidsupport.org/autoinflammatory-vs-autoimmune-what-is-the-difference, https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=immunofixation_blood, https://patient.uwhealth.org/healthwise/article/hw43650, What You Need to Know About Blood Testing, U.S. Department of Health and Human Services, Numbness or tingling in the face, arms and/or legs, Inflammatory diseases, a condition when the body's immune system attacks healthy tissues by mistake. They have a number of roles: Too much or too little protein can cause problems. https://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/monoclonal-gammopathy-of-undetermined-significance-mgus?query=mgus. 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. Complete Blood Count (CBC). Since the expression levels of these genes and how mutations in them, if present, influence the behavior of the myeloma cells, these techniques may be helpful in better predicting treatment outcomes and developing new and improved targeted therapies. Browse the 32 health-related programs and part-time courses available at BCITs School of Health Sciences. Sometimes, however, the results of this examination can be confusing or difficult to interpret. When the body produces abnormal antibodies, they are called monoclonal proteins, or M proteins. Most patients with untreated myeloma have a monoclonal immunoglobulin spike in serum, urine, or both. Bone marrow biopsy may be useful to show aggregates of plasma cells in focal or diffuse patterns. 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. Both types of blood cells (red and white) and platelets are solids. If the result is negative, it is safe to conclude that a pure kappa or lambda light chain is present. Following my rotation in Anatomical Pathology, I spent one week on accessioning review and another three in Chemistry. Diagnosis of monoclonal gammopathy of undetermined significance. Your doctor may also order more tests. The albumin level is decreased under circumstances in which there is less production of the protein by the liver or in which there is increased loss or degradation of this protein. Also, M proteins may not be apparent on electrophoresis. 2010. Beta1 is composed mostly of transferrin, and beta2 contains beta-lipoprotein. Patients with monoclonal gammopathy of undetermined significance require close follow-up because about 1 percent per year develop multiple myeloma or another malignant monoclonal gammopathy.13 [Evidence level B, prospective cohort study] An algorithm for the follow-up of patients with a monoclonal gammopathy is provided in Figure 3.6. 109:585-8. Monoclonal gammopathy of undetermined significance (MGUS). 1 It's called a monoclonal . Urine IFE tests are often done if IFE blood test results were not normal. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. 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. 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. In Kelowna I had the week of review, and go out 2-3 mornings a week while in Chem and Hematology. This is a test that determines whether abnormal plasma cells are present in a liquid sample of bone marrow aspirate or blood. Characterized by a sharp peak in the beta-gamma region, monoclonal gammopathies involve increased production of immunoglobulins, or antibodies (IgA, IgG, IgM, etc.). Peripheral blood smear often shows RBCs in a stacked or rouleaux formation. IgA or IgM bands are less common. Thus, it is most often present in the blood but not in the urine. [18, 19], Detection of a paraprotein by immunofixation is possible in lymphomas. The Licensed Content is the property of and copyrighted by DSM. Monoclonal antibodies could be used as myeloma treatments and can be identified by serum protein electrophoresis and immunofixation electrophoresis. Bone marrow aspirate may be useful to show that at least 10% of the nucleated blood cells are plasma cells. Therefore, such an approach cannot be currently recommended. A serum free light chain ratio is indicated in the case of a negative immunofixation result when the suspicion for multiple myeloma is still high. This content is owned by the AAFP. An immunofixation blood test, also known as protein electrophoresis, measures certain proteins in the blood. Please check with your financial advisor if you have more questions. Synonym (s): paraprotein (2) . [ 1] Serum or urine immunofixation negative for a monoclonal protein or a polyclonal pattern is. Available from: https://ufhealth.org/protein-electrophoresis-serum. To confirm the former and because of the latter, if there is a high index of clinical suspicion, immunofixation studies are required. The article also provides a simple guide to result interpretation and suggestions on follow-up of abnormal results. Malnutrition; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. Available from: Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 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. [QxMD MEDLINE Link]. You don't need any special preparations for an immunofixation blood test. In: Ferri's Clinical Advisor 2019. Available from: UW Health [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. It's easier to check your kidney health at home now more than ever. Waldenstrom macroglobulinemia always shows a serum IgM-type monoclonal band. Share cases and questions with Physicians on Medscape consult. Ceruloplasmin, alpha2-macroglobulin, and haptoglobin contribute to the alpha2-protein band. Haematologica. Monoclonal gammopathy of undetermined significance (MGUS). StatPearls. A polyclonal immunoglobulin pattern in the serum or urine immunofixation is considered to be nonspecific. Luzzio C, Dangond F. Multiple sclerosis. 135:1048-51. For patients with MGUS and high risk for progression to multiple myeloma, surveillance should be performed at 6 months and then yearly thereafter. Kaplan JS, Horowitz GL. This test is called serum protein electrophoresis (SPEP) test. Yet, every person's myeloma is unique. The disorder occurs most commonly in older men.