Affected patients have no lytic bone lesions, no anemia, no hypercalcemia, and no renal disease. Lab Tests Online [Internet]. . If the curve is relatively normal (e.g. If there are not CRAB signs and/or symptoms, 60% plasma cells in the bone marrow indicates a diagnosis. Inflammatory Disease/Inflammation; [cited 2019 Dec 18]; [about 3 screens]. what does no apparent monoclonal protein on serum electrophoresis mean. San Francisco: Said Support; c2013-2016. A homogeneous spike-like peak in a focal region of the gamma-globulin zone indicates a monoclonal gammopathy. Thanks for helping me with this quality post. Serum protein electrophoresis (SPEP) is a laboratory technique thats used to determine the levels of some types of proteins in a blood sample. [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. Available from: Lab Tests Online [Internet]. BCIT students get their phlebotomy competencies signed off during a two-week placement in Level 1, so whether you collect blood during the long block practicum is very much dependent on the practicum site. To use the sharing features on this page, please enable JavaScript. Once the serum samples are run on the analyzer, a technologist compares the curves with patients previous results and ensures the fractions are appropriately delineated. It can also can vary in how that amount relates to the behavior of the myeloma. Urine immunofixation uses electricity to push proteins from your urine sample through a kind of gel. These symptoms could include the following: Some of the conditions that could be causing these symptoms are: No preparation is needed for the test. In addition, when protein electrophoresis assays are positive for a monoclonal protein, serum and urine immunofixation are indicated for the appropriate identification of the immunoglobulin and the corresponding light chain. On a computer screen, these proteins form a pattern of bands. 5 fractions are shown in this image: albumin, alpha-1 ( 1 ), alpha-2 ( 2 ), beta () and gamma (). The immunoelectrophoresis-serum test is used to. Malnutrition; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. Available from: Lab Tests Online [Internet]. Available from: Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. [11] HIV-related encephalitis, neurosyphilis, Lyme meningoencephalitis, neurosarcoidosis, acute disseminated encephalomyelitis (ADEM), systemic lupus erythematosus (SLE), Sjgren syndrome, subacute sclerosing panencephalitis, CNS malignancy, neuromyelitis optica, and transverse myelitis can all reveal oligoclonal banding in CSF immunofixation, precluding the use of immunofixation for the detection of oligoclonal bands as a sole diagnostic technique in multiple sclerosis. Tax Identification Number: 13-5644916, Myeloma Guide: Information for Patients and Caregivers, A bone marrow aspirationto remove a liquid marrow sample, A bone marrow biopsyto remove a small amount of bone filled with marrow, Malignant plasma cells: Plasma cell level of >10% in a bone marrow biopsy sample, Unusually large amounts of monoclonal protein (called an M spike). 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 alpha2 component is increased as an acute-phase reactant. Serum free light chain testing provides complementary information to the two protein electrophoresis tests: SPEP and UPEP. However, most patients with a monoclonal protein will be finally diagnosed with MGUS rather than any of the malignant plasma cell dyscrasias for which treatment is recommended. Join the BCIT conversation on social media. In Kelowna I had the week of review, and go out 2-3 mornings a week while in Chem and Hematology. The remainder had hypogammaglobulinemia or a normal-appearing pattern. The SFLC assay can detect abnormal levels of free light chains, which may be an indication of a plasma cell disorder. Shah D, Seiter K. Multiple myeloma. 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. The pattern of serum protein electrophoresis results depends on the fractions of two major types of protein: albumin and globulins. 109:585-8. The presence of a suspected monoclonal can lead to further testing by immunofixation electrophoresis (IFE). [Full Text]. If a monoclonal protein is present, a precipitant will form at this phase. CBC often reveals a normochromic normocytic anemia. Last medically reviewed on October 20, 2016, Proteins are found in the blood of healthy people. 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. When you arrive, a healthcare professional will simply use a needle to take a blood sample. In addition to SPEP followed by immunofixation, quantitative serum immunoglobulin should be performed, because the M component must be greater than3 g/dL in the serum. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. If the result is negative, it is safe to conclude that a pure kappa or lambda light chain is present. 2015 Aug 26. Twenty-four-hour Bence-Jones protein determinations: can we ensure accuracy?. The disorder occurs most commonly in older men. If you have high amounts of this protein in your blood, it's important to have regular checkups so that you can get earlier treatment if it does progress. Available from: National Heart, Lung, and Blood Institute [Internet]. [1] Serum or urine immunofixation negative for a monoclonal protein or a polyclonal pattern is considered to be normal. What Is M Protein? [14], Mass spectrometry is sometimes employed in place of immunofixation because of the latters limitations, such as in the detection of low-level disease. The precise cause of MGUS isn't known. Fanning SR, Hussein MA. Your doctor can use it to confirm certain diagnoses. Levels of albumin are increased in patients with a relative reduction in serum water (e.g., dehydration). However, blood has several components. Consequently, urine protein electrophoresis is recommended in all patients suspected of having a plasma cell dyscrasia.10. [10, 17], A 24-hour concentrated urine sample is appropriate for urine immunofixation. It should be noted that immunoglobulins often can be found throughout the electrophoretic spectrum. SPEP is used to help diagnose and monitor a variety of different diseases or disorders that have abnormal proteins or protein levels. Affected patients have hyperviscosity and hypercellular bone marrow with extensive infiltration by lymphoplasma cells. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: leukemia; [cited 2019 Dec 10]; [about 3 screens]. Evol Med Public Health. 5th. These tests are performed when the IFE blood test doesn't give . Genetic changes and environmental triggers appear to play a role. https://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/monoclonal-gammopathy-of-undetermined-significance-mgus?query=mgus. 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 Often, there are associated decreases in the albumin and transferrin levels.6 Table 26 lists characteristic patterns of acute-reaction proteins found on serum protein electrophoresis, along with associated conditions or disorders. 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. 5 fractions are shown in this image: albumin, alpha-1 (1), alpha-2 (2), beta () and gamma (). [ 1] Serum or urine immunofixation negative for a monoclonal protein or a polyclonal pattern is. Available from: https://ufhealth.org/protein-electrophoresis-serum. LLS funds lifesaving blood cancer research around the world, provides free information and support services, and is the voice for all blood cancer patients seeking access to quality, affordable, coordinated care. Profile Information: Reflex Test: The identification of a monoclonal gammopathy depends on serum and urine protein electrophoresis and immunoelectrophoresis (IFE) 1 and/or quantitative free light chain assays. This means that high or low levels of the five protein types examined during the test can point to different illnesses. Highly trained oncology social workersand nurses. The patient urinates each time into a clean dry vessel and then pours the urine in the plastic container, which is kept at a cold temperature (eg, in the refrigerator). Copyright 2023 Haymarket Media, Inc. All Rights Reserved Less than 10% plasma cells are present in bone marrow, and patients have no lytic bony lesions, anemia, hypercalcemia, or renal insufficiency. Also, M proteins may not be apparent on electrophoresis. 2011. There are two main types of proteins in the blood: albumin and globulin. A malignant plasma cell is called a . Merck Manual Professional Version. Inflammatory diseases include. Serum is placed on a specific medium, and a charge is applied. Monoclonal gammopathy of undetermined significance. Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. Enter your information to receive occasional news and important updates! Protein electrophoresis serum : Overview; [updated 2021 Aug 9; cited 2021 Aug 9]; [about 2 screens]. In fact, if no monoclonal component is detected by serum protein electrophoresis, immunofixation interpretation with bone marrow evaluation determines the type of response, stratifying. This whole (intact) immunoglobulin, made of the four chains, is usually too large to pass through the kidney. The subgroups are: Measuring the proteins in each subgroup can help diagnose a variety of diseases. Mayo Clinic, Rochester, Minn. April 26, 2019. Our mission is to provide practice-focused clinical and drug information that is reflective of current and emerging principles of care that will help to inform oncology decisions. Learn why immunohistochemistry is the gold standard in testing for certain diseases, including several cancers. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. 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. Protein Electrophoresis; p. 430. How is a urine sample collected for an immunofixation test? If abnormal, the curve may be delineated in the wrong location(s) and should be fixed before the result is filed. Serum protein electrophoresis is an inexpensive, easy-to-perform screening procedure for initial identification of monoclonal bands. [QxMD MEDLINE Link]. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Seiter K, Ponce D. Waldenstrom macroglobulinemia. Cytogenetic Analysis. 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. Both types of blood cells (red and white) and platelets are solids. How is an immunofixation test interpreted? SPEP and UPEP don't measure myeloma cells; they measure the output of myeloma cells. Next-generation sequencing is being done now on a research basis but may soon be used in routine clinical practice. We use cookies to enhance your experience. Available from: Lab Tests Online [Internet]. Washington D.C.: American Association for Clinical Chemistry; c20012019. Mass spectrometry for the evaluation of monoclonal proteins in multiple myeloma and related disorders: an International Myeloma Working Group Mass Spectrometry Committee Report. Protein electrophoresis immunofixation electrophoresis. It may also depend on the unique patterns made by the proteins. [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. 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. The information on this site should not be used as a substitute for professional medical care or advice. Your doctor tests your bone marrow to look for malignant plasma cells. Medscape Drugs & Diseases. Skeletal lesions (e.g., lytic lesions, diffuse osteopenia, vertebral compression fractures) are present in 80 percent of patients. Beaumont-Epinette MP, Moreau C, Besnard S, Latute F, Collet N, Sebillot M, et al. URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. excess of an abnormal immunoglobulin called monoclonal protein (or M protein). This test measures the numbers of red blood cells, white blood cells and platelets in the blood. The serum immunofixation test is most often done with a blood sample. This abnormal protein is formed within your bone marrow, the soft, blood-producing tissue that fills in the center of most of your bones. 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. Diseases that produce an increase in the gamma-globulin level include Hodgkins disease, malignant lymphoma, chronic lymphocytic leukemia, granulomatous diseases, connective tissue diseases, liver diseases, multiple myeloma, Waldenstrms macroglobulinemia, and amyloidosis.3,7, Although many conditions can cause an increase in the gamma region, several disease states cause a homogeneous spike-like peak in a focal region of the gamma-globulin zone (Figure 2). Bone marrow aspirate may be useful to show that at least 10% of the nucleated blood cells are plasma cells. There are five types of heavy chains, and each type is represented by a specific letter: IgG, IgA, IgD, IgE and IgM. https://www.uptodate.com/contents/search. Urine IFE tests are often done if IFE blood test results were not normal. 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. Proteins are substances made of small chemicals called amino acids. Head over to share your story and tell us about it. Available from: National Cancer Institute [Internet]. On the left a serum protein electrophoresis (SPEP) of a patient with a monoclonal band in the gamma region is shown. The subsets of these proteins and their relative quantity are the primary focus of the interpretation of serum protein electrophoresis.1,3. 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. Guido Tricot. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. Madison (WI):University of Wisconsin Hospitals and Clinics Authority; c2021. Benign monoclonal proteins were first described by Dr. Jan Waldenstrm in 1960 after he detected abnormal narrow hypergammaglobulinemia bands in serum protein electrophoresis (SPEP) samples from healthy individuals. Serum protein electrophoresis is the easiest means of excluding the presence of a monoclonal protein and can detect bands of 0.5 gm/dL or less. This pattern represents the presence of polyclonal immunoglobulin. 2011. What is the clinical application of an immunofixation test? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019. Share cases and questions with Physicians on Medscape consult. Peripheral blood contains more than 20 percent plasma cells. 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. In addition, doctors stagemyeloma to help them decide on the best treatmentplan. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. 135:1048-51. 2017 Dec 28. Urine protein electrophoresis (UPEP) is, C-reactive protein is produced by the liver in response to inflammation. There are several reasons a patients SPE curve could be abnormal. M protein is an abnormal protein caused by plasma cells. 2009. AskMayoExpert. (2015, August 12), Serum protein electrophoresis. In: Goldman-Cecil Medicine. Luzzio C, Dangond F. Multiple sclerosis. Some people experience mild pain when the needle is inserted. 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. cancer cells lead to abnormal immunoglobulins; their build-up negatively affects the formation and function of normal blood cells, the kidneys, and neurologic state, amongst other things. The examination also should be considered in other red flag situations (Table 1).24, If the examination is normal but multiple myeloma, Waldenstrms macroglobulinemia, primary amyloidosis, or a related disorder still is suspected, immunofixation also should be performed because this technique may be more sensitive in identifying a small monoclonal (M) protein.5. Bird J, Behrens J, Westin J, et al. Cancer.Net [Internet]. Common causes of high levels include: Low protein levels may be caused by many conditions. 1976. Waldenstrom macroglobulinemia always shows a serum IgM-type monoclonal band. A decreased alpha1-protein band may occur because of alpha1-antitrypsin deficiency or decreased production of the globulin as a result of liver disease. Bone marrow examination may be informative. Making sense of serum protein bands. An immunofixation blood test, also known as protein electrophoresis, measures certain proteins in the blood. 2019 Jul 15. There is greater than 10 percent plasma cell involvement on bone marrow biopsy. This website also contains material copyrighted by 3rd parties. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process, and they usually are associated with nonmalignant conditions. Medscape Drugs & Diseases. Health Encyclopedia: Immunofixation (Blood); [cited 2019 Dec 10]; [about 2 screens]. Subsequent immunofixation with electrophoresis identified the monoclonal protein as an IgG antibody (paraprotein) with a lambda light chain (arrow). When the whole immunoglobulin is present in the urine, it is usually at a low level. Following my rotation in Anatomical Pathology, I spent one week on accessioning review and another three in Chemistry.
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