Following my rotation in Anatomical Pathology, I spent one week on accessioning review and another three in Chemistry. In myeloma, large amounts of a single antibody are noted as a monoclonal immunoglobulin spike or monoclonal spike (M spike), indicating that the protein came from cells that originally started as single, malignant cell. When is an immunofixation test indicated? 117:4701-5. We want you to take advantage of everything Cancer Therapy Advisor has to offer. Lab Tests Online [Internet]. Blood Cancer J. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. Immunofixation tests can also be done in urine. 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. It's easier to check your kidney health at home now more than ever. Other more-specific tests, including serum protein electrophoresis (SPEP), can help determine the exact source, such as liver or bone marrow. This abnormal protein is formed within your bone marrow, the soft, blood-producing tissue that fills in the center of most of your bones. Electrophoresis is a lab technique used to separate groups of proteins in blood serum. This test is most often used to help diagnose or monitor a variety of different conditions. Subsequent immunofixation with electrophoresis identified the monoclonal protein as an IgG antibody (paraprotein) with a lambda light chain (arrow). Last medically reviewed on October 20, 2016, Proteins are found in the blood of healthy people. If abnormal, the curve may be delineated in the wrong location(s) and should be fixed before the result is filed. Burns also may result in a low albumin level. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant. Close more info about Monoclonal Protein on Serum Protein Electrophoresis (M Component), Metabolic Alkalosis: Arterial Blood pH Elevated with Increased Arterial pCO2. Bird J, Behrens J, Westin J, et al. StatPearls. 133 (25):2664-8. The next five components (globulins) are labeled alpha1, alpha2, beta1, beta2, and gamma. 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. Immune Thrombocytopenia Purpura (ITP): What helps? If the repeat examination is abnormal or future patterns are abnormal, the next step is to refer the patient to a hematologist-oncologist. Sign-upto receive the latest news on BCIT. Protein electrophoresis serum : Overview; [updated 2021 Aug 9; cited 2021 Aug 9]; [about 2 screens]. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. Here are my blood test results for "Interpretation" part. 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. (2015, August 12), Serum protein electrophoresis. 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. Immunofixation electrophoretic techniques applied to identification of proteins in serum and cerebrospinal fluid. MGUS usually causes no problems. M-protein level is greater than 3 g per dL. Also, M proteins may not be apparent on electrophoresis. Some of these patients can befollowed with a newer blood test that measures serum free light chains, which are asmall fragment of the larger intact M protein., An intact immunoglobulin (Ig) molecule is composed of two larger pieces (heavy chains) and two smaller pieces (light chains) that are attached to each other. [10, 17], A 24-hour concentrated urine sample is appropriate for urine immunofixation. They have a number of roles: Too much or too little protein can cause problems. The identification of a monoclonal immunoglobulin is helpful in the diagnosis of the following conditions These tests are performed when the IFE blood test doesn't give . Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. A total protein test can determine whether you have high blood protein. In: Ferri's Clinical Advisor 2019. Efficacy and outcome of autologous transplantation in rare myelomas. 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. Mass spectrometry for the evaluation of monoclonal proteins in multiple myeloma and related disorders: an International Myeloma Working Group Mass Spectrometry Committee Report. As denoted in the normal curve above, antibodies are primarily found in the fraction. MGUS is usually detected by chance when you have a blood test for another condition. Learn more about laboratory tests, reference ranges, and understanding results. Merck Manual Professional Version. No monoclonal band is identified. Tests are done to measure the levels of many different substances in the blood. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Is there something going on we should know about? If serum protein electrophoresis is abnormal at any time during the follow-up, a referral should be made. These include an elevated protein level, anemia and abnormalities in kidney function or calcium levels. 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. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjA4Njk3Ni1vdmVydmlldw==. Electrophoresis describes the migration of charged particles in an electric field, and their subsequent separation based on size and charge. This test is called serum protein electrophoresis (SPEP) test. Medscape Drugs & Diseases. Globulins comprise a much smaller fraction of the total serum protein content. The most common type of myeloma is IgG kappa, occurring in approximately 52 % of patients. It measures the amount of two kinds of protein in your body, albumin and globulin. 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. The article also provides a simple guide to result interpretation and suggestions on follow-up of abnormal results. Ronald Hoffman, Leslie E. Silberstein, Sanford J. Shattil, Bruce Furie, Philip McGlave. In a normal result, the lanes are broad and there is a gradual and smooth reduction in the color density toward the edges of the lane with no narrow dense band with sharp borders identified within the lane. Peaks and valleys in the bands may mean that you may be making too many or too few of certain proteins. 2021 Feb 1. Bone Marrow Tests. This whole (intact) immunoglobulin, made of the four chains, is usually too large to pass through the kidney. Blood appears to be a single substance to the naked eye. Urbancek S, Gascon P, Schwartz RA, Jacobson DR, Buxbaum JN, Bogdan CA. https://www.uptodate.com/contents/search. [10]. Urine Test. Hematocrit is a blood test that is used to determine if you have low levels of hemoglobin in your blood (a condition called anemia). 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. This monoclonal gammopathy occurs in younger patients. Many subspecialists. Mayo Clinic does not endorse companies or products. The Licensed Content is the property of and copyrighted by DSM. IgA or some other type). Keywords: bone marrow; monoclonal protein; multiple myeloma; protein electrophoresis; serum free light chains. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: lymphoma; [cited 2019 Dec 10]; [about 3 screens]. If Waldenstrms macroglobulinemia or other lymphoproliferative process is suspected, an abdominal computed tomographic scan and bone marrow aspiration and biopsy should be performed. However, the presence of oligoclonal bands does not necessarily confirm the diagnosis, as other conditions can present with oligoclonal bands in the CSF. Enter your information to receive occasional news and important updates! Luzzio C, Dangond F. Multiple sclerosis. Malabsorption; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. Kyle RA, Durie BG, Rajkumar SV, 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. [18, 19], Detection of a paraprotein by immunofixation is possible in lymphomas. Cancer.Net [Internet]. 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. Alexandria (VA): American Society of Clinical Oncology; 20052019. Autoinflammatory vs. Autoimmune: What is the Difference? 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. Red top tube for the collection of serum used. Immunofixation to identify the M component as an IgM immunoglobulin with a quantitative IgM level greater than 3 g/dL. Ferri FF. Alpha-1 Antitrypsin; [updated 2019 Nov 13; cited 2019 Dec 10]; [about 2 screens]. MGUS causes no symptoms. Given the dismal impact on prognosis in the latter scenario, This process is known as electrophoresis. Urine IFE tests are often done if IFE blood test results were not normal. You are being redirected to Health Encyclopedia: Immunofixation (Blood); [cited 2019 Dec 10]; [about 2 screens]. If the monoclonal protein level decreases or is undetectable after chemotherapy, it might indicate a response to treatment. Therefore, the International Myeloma Working Group Mass Spectrometry Committee created a set of recommendations for the evaluation of monoclonal proteins in multiple myeloma and related disorders, using mass spectrometry. 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. A monoclonal protein is produced by the abnormal, cancerous or precancerous cells. In healthy individuals, antibodies produced by plasma cells in the bone marrow help this process. A decreased alpha1-protein band may occur because of alpha1-antitrypsin deficiency or decreased production of the globulin as a result of liver disease. The gamma-globulin zone is decreased in hypogammaglobulinemia and agammaglobulinemia. This content does not have an Arabic version. Plasma protein levels display reasonably predictable changes in response to acute inflammation, malignancy, trauma, necrosis, infarction, burns, and chemical injury. Available from: UW Health [Internet]. Available from: National Heart, Lung, and Blood Institute [Internet]. [Full Text]. Available from: Lab Tests Online [Internet]. 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. One pathologic reason which we covered at BCIT is a monoclonal gammopathy. Thus, it is most often present in the blood but not in the urine. Making sense of serum protein bands. In addition, a beta2 microglobulin test, a CRP test, and a 24-hour urine collection for electrophoresis and immunofixation should be performed. 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). Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Please check with your financial advisor if you have more questions. Copyright 2017, 2013 Decision Support in Medicine, LLC. Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. The LLS mission: Cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. what does no apparent monoclonal protein on serum electrophoresis mean. 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. correct number of peaks and protein values), the analyzer does a pretty good job of identifying each fraction. The lab will also treat the gel so that it only keeps . 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. Washington D.C.: American Association for Clinical Chemistry; c20012019. 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 proteins create separate bands on the gel, which are then analyzed by the laboratory. Youve read {{metering-count}} of {{metering-total}} articles this month. If there's no disease progression, MGUS doesn't require treatment. [Internet]. M protein is an abnormal protein caused by plasma cells. URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. Monoclonal gammopathies are conditions in which abnormal proteins are found in the blood. Continuing Medical Education (CME/CE) Courses. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. [2] : Monoclonal gammopathy of undetermined significance (MGUS) Blood is collected in a tube with clot activator. When you arrive, a healthcare professional will simply use a needle to take a blood sample. Protein Electrophoresis, Immunofixation Electrophoresis; [updated 2019 Oct 25; cited 2019 Dec 10]; [about 2 screens]. 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. [Full Text]. The test may also be performed again in the future. 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. Kaplan JS, Horowitz GL. If the result is negative, it is safe to conclude that a pure kappa or lambda light chain is present. Monoclonal gammopathy of undetermined significance (MGUS) is a condition in which an abnormal protein known as monoclonal protein or M protein is in your blood. Are you a BCIT News insider? Low concentration of monoclonal immunoglobulins (LCMI) Heavy chain disease Suggested Additional Lab Testing For multiple myeloma: In addition to SPEP followed by immunofixation, quantitative. Cavuoti D, Baskin L, Jialal I. . It may also depend on the unique patterns made by the proteins. 95:2126-33. 32 health-related programs and part-time courses, BCIT organized a record-breaking pancake breakfast fundraiser, From business to metal fabrication: Former MBA student follows her passion for trades, How Flexible Learning helps build your resume and career, Life at BCIT: International student makes connections and promotes well-being among her peers - Post-Secondary BC, From education to employment: Why international students choose BCIT, Winning at the game of love: An 80s alumni love story, Digital Arts, Media + Design Online Info Session, Technical Writing Flexible Learning Online Info Session, Mass Timber Construction Principles and Practice. If the sample is hemolyzed in vitro (red blood cells are ruptured outside the body such as during traumatic blood draw), there will be free hemoglobin, which migrates to the 1 fraction. Affected patients have few bone lesions and few hematologic disturbances. Less than 10% plasma cells are present in bone marrow, and patients have no lytic bony lesions, anemia, hypercalcemia, or renal insufficiency. Available from: https://ufhealth.org/protein-electrophoresis-serum. In Kelowna I had the week of review, and go out 2-3 mornings a week while in Chem and Hematology. The presence of a suspected monoclonal can lead to further testing by immunofixation electrophoresis (IFE). Goldman L, et al., eds. These proteins can also be referred to as an M-spike, monoclonal immunoglobulin, or paraprotein. Under the PE Value it says: "SPE1". SPEP is used to help diagnose and monitor a variety of different diseases or disorders that have abnormal proteins or protein levels. Healthcare providers treat the underlying cause of the immune response to help treat polyclonal gammopathy. An endoscopy is used in a wide range of testing throughout the body. 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. 2015 Aug 26. A homogeneous spike-like peak in a focal region of the gamma-globulin zone indicates a monoclonal gammopathy.

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