The IFX test can also be used to study changes in the structure of normal. Many subspecialists include serum protein electrophoresis screening in the initial evaluation for numerous clinical conditions. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. This allows them to be measured and analyzed individually. 2019 Jun 20. 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. 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. Morris C, Drake M, Apperley J, et al. My first week back in Chem was spent on the electrophoresis bench. Following my rotation in Anatomical Pathology, I spent one week on accessioning review and another three in Chemistry. To confirm the former and because of the latter, if there is a high index of clinical suspicion, immunofixation studies are required. [QxMD MEDLINE Link]. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Is there something going on we should know about? This whole (intact) immunoglobulin, made of the four chains, is usually too large to pass through the kidney. Because MGUS is not harmful, it doesn't need to be treated. Inflammatory diseases include. 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. Affected patients have hyperviscosity and hypercellular bone marrow with extensive infiltration by lymphoplasma cells. If Waldenstrms macroglobulinemia or other lymphoproliferative process is suspected, an abdominal computed tomographic scan and bone marrow aspiration and biopsy should be performed. That criteria is determined by a pathologist who reviews the bone marrow aspirate slides. Anemia, pancytopenia, hypercalcemia, and renal disease may be present. Waldenstrom macroglobulinemia always shows a serum IgM-type monoclonal band. Urine immunofixation uses electricity to push proteins from your urine sample through a kind of gel. This website also contains material copyrighted by 3rd parties. Hematology: Basic Principles and Practice. As denoted in the normal curve above, antibodies are primarily found in the fraction. 5 fractions are shown in this image: albumin, alpha-1 ( 1 ), alpha-2 ( 2 ), beta () and gamma (). No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. A homogeneous immunoglobulin resulting from the proliferation of a single clone of plasma cells that; during electrophoresis of serum, appears as a narrow band or "spike"; it is characterized by heavy chains of a single class and subclass, and light chains of a single type. Seiter K, Ponce D. Waldenstrom macroglobulinemia. The band pattern is specific for certain diseases. Role of urine immunofixation in the complete response assessment of MM patients other than light-chain-only disease. Clin Chem. Also, M proteins may not be apparent on electrophoresis. Affected patients have few bone lesions and few hematologic disturbances. 2015 Aug 26. The identification of a monoclonal immunoglobulin is helpful in the diagnosis of the following conditions Sign-upto receive the latest news on BCIT. 2021 Feb 1. It measures the amount of two kinds of protein in your body, albumin and globulin. CancerTherapyAdvisor.com is a free online resource that offers oncology healthcare professionals a comprehensive knowledge base of practical oncology information and clinical tools to assist in making the right decisions for their patients. 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. Cancer.Net [Internet]. 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. Serum protein electrophoresis is used to identify patients with multiple myeloma and other serum protein disorders. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The precise cause of MGUS isn't known. Profile Information: Reflex Test: [13, 14], Diagnosis of plasma cell dyscrasias Comparison of the Freelite serum free light chain (SFLC) assay with serum and urine electrophoresis/immunofixation and the N Latex FLC assay. 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. Abnormal levels of certain chemicals may indicate that an organ is not working properly or they may be caused by cancer or other health conditions. Fluorescence in situ hybridization (FISH) is a type of laboratory test that uses special dyes to identify mutations of specific chromosomes in cells. Complete Blood Count (CBC). Monoclonal antibodies could be used as myeloma treatments and can be identified by serum protein electrophoresis and immunofixation electrophoresis. This is a test that determines whether abnormal plasma cells are present in a liquid sample of bone marrow aspirate or blood. Available from: National Multiple Sclerosis Society [Internet]. These include: You may need testing if you have symptoms of certain diseases, such as multiple myeloma, multiple sclerosis, malnutrition, or malabsorption. Platelets Small substances in your blood that help the blood to form a thickened mass (or blood clot) to help stop bleeding. Detection of oligoclonal bands in cerebrospinal fluid by immunofixation electrophoresis. Endoscopy vs. Colonoscopy: How Do They Differ? Youve read {{metering-count}} of {{metering-total}} articles this month. StatPearls. We avoid using tertiary references. Urine immunoelectrophoresis is a lab test that measures immunoglobulins in a urine sample. Accessed April 18, 2019. Most patients with untreated myeloma have a monoclonal immunoglobulin spike in serum, urine, or both. You are being redirected to
2010. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 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 net charge (positive or negative) and the size and shape of the protein commonly are used in differentiating various serum proteins.1. There is less than 10 percent plasma cell involvement on bone marrow biopsy. Ceruloplasmin, alpha2-macroglobulin, and haptoglobin contribute to the alpha2-protein band. Blood is collected in a tube with clot activator. Monoclonal bands are usually seen in the zone but may be seen in proximity of the band or, rarely, in the 2 region. Guido Tricot. The alpha1-protein fraction is comprised of alpha1-antitrypsin, thyroid-binding globulin, and transcortin. 2015 May. 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. 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. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. [QxMD MEDLINE Link]. MGUS is characterized by a serum IgG monoclonal protein less than 3.5 g/dL or IgA paraprotein less than 2 g/dL, with no or only a small amount of protein in urine (Bence Jones protein < 1 g/24 hr). Malabsorption; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. Electrophoresis describes the migration of charged particles in an electric field, and their subsequent separation based on size and charge. Available from: Cancer.Net [Internet]. 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. The following table shows what most labs would consider normal results for SPEP testing. The albumin band represents the largest protein component of human serum. A doctor may use the results to make a diagnosis or decide on a course of treatment. Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. If all tests are normal, the pattern of follow-up in Figure 36 can be undertaken. 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. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. Dimopoulos M, Kyle R, Fermand JP, et al. There are several reasons a patients SPE curve could be abnormal. 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. Is there a person or breakthrough we should celebrate? The stained gel is then sent to a pathologist for diagnosis. Peripheral blood contains more than 20 percent plasma cells. Common causes of high levels include: Low protein levels may be caused by many conditions. Posts: 33. 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. 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. When might mass spectrometry be used in place of immunofixation? How is a urine sample collected for an immunofixation test? Malignancy and acute inflammation (resulting from acute-phase reactants) can increase the alpha1-protein band. 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. (2015, August 12), Serum protein electrophoresis. Available from. All of these measurements provide information about the extent of the disease and are useful for monitoring response to treatment. Serum protein electrophoresis is an inexpensive, easy-to-perform screening procedure for initial identification of monoclonal bands. Rajhumar SV. The proteins create separate bands on the gel, which are then analyzed by the laboratory. Again, the lanes are broad and the transition to the lane borders is smooth. Affected patients have no lytic bone lesions, no anemia, no hypercalcemia, and no renal disease. San Francisco: Said Support; c2013-2016. Continuing Medical Education (CME/CE) Courses. Washington D.C.: American Association for Clinical Chemistry; c20012019. See additional information. Synonym (s): paraprotein (2) . Serum Protein Electrophoresis (SPEP) Test; [cited 2021 Aug 9]; [about 3 screens]. There are two types of light chains, referred to as kappa (k) and lambda ().. Home Decision Support in Medicine LabMed, Monoclonal gammopathy of unknown significance (MGUS), Low concentration of monoclonal immunoglobulins (LCMI). Blood. 2019 Jan. [QxMD MEDLINE Link]. Monoclonal proteins can be either intact monoclonal immunoglobulins or immunoglobulin light chains (Bence Jones proteins) found in the blood and/or urine. The most common condition linked with these abnormal proteins is MGUS. All Rights Reserved. Under the PE Value it says: "SPE1". There are two main types of proteins in the blood: albumin and globulin. What is the clinical application of an immunofixation test? [Full Text]. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant. 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. Mayo Clinic does not endorse companies or products. Available from: UW Health [Internet]. You can learn more about how we ensure our content is accurate and current by reading our. Follow our channels and share your own adventure. 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. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. Typically present in low amounts, conditions such as multiple myeloma and Waldenstrms macroglobulinemia show proliferation of abnormal or cancerous plasma cells. What is the reference range of an immunofixation test? This test is most often used to help diagnose or monitor a variety of different conditions. How is a CSF sample collected for an immunofixation test? In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process. (2015, August 21). Low concentration of monoclonal immunoglobulins (LCMI) Heavy chain disease Suggested Additional Lab Testing For multiple myeloma: In addition to SPEP followed by immunofixation, quantitative. If abnormal, the curve may be delineated in the wrong location(s) and should be fixed before the result is filed. In some cases, the test is done with a urine sample. [20]. UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): guidelines for the investigation of newly detected M-proteins and the management of monoclonal gammopathy of undetermined significance (MGUS). In other cases, patients may have non-specific symptoms, meaning the discovery of a protein band in the serum . A concomitant measurement of the creatinine in the 24-hour urine sample for correction of sampling errors has been proposed. Alexandria (VA): American Society of Clinical Oncology; 20052019. We look forward to connecting with you. The specimen can be serum, urine, or CSF. The test may also be performed again in the future. Finally, the sample is washed to remove the proteins that do not precipitate and then stained, destained, and dried. If multiple myeloma still is considered clinically in a patient who does not have an M-protein spike on serum protein electrophoresis, urine protein electrophoresis should be performed. 2009. What specimens can be used to perform an immunofixation test? These conditions should be promptly diagnosed and treated. Immunofixationconsists of an electrophoresis phase and a fixation phase. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. Flow Cytometry. Approximately 40 percent of myeloma cases are characterized by the presence of trisomies (three copies of a chromosome) in the malignant plasma cells, while in most of the rest there is a translocation involving chromosome 14 (the site of a gene for the immunoglobulin heavy chain). Collection in a container: A plastic collection container is used. 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. Madison (WI):University of Wisconsin Hospitals and Clinics Authority; c2021. Immunofixation to identify the M component as an IgM immunoglobulin with a quantitative IgM level greater than 3 g/dL. The remainder had hypogammaglobulinemia or a normal-appearing pattern. There are a number of reasons why a doctor may order this test. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, for Monoclonal gammopathy of undetermined significance (MGUS), Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Monoclonal gammopathy of undetermined significance (MGUS), Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Essential Thrombocythemia: Looking for information and support. Want to view more content from Cancer Therapy Advisor? Monoclonal gammopathies are conditions in which abnormal proteins are found in the blood. Myeloma affects white blood cells called plasma cells in the bone marrow. Other more-specific tests, including serum protein electrophoresis (SPEP), can help determine the exact source, such as liver or bone marrow. There are five types of heavy chains, and each type is represented by a specific letter: IgG, IgA, IgD, IgE and IgM. 133 (25):2664-8. Bone marrow aspirate may be useful to show that at least 10% of the nucleated blood cells are plasma cells. In some patients, the myeloma cells do not make a complete monoclonal immunoglobulin molecule with two heavy and two light chains. A malignant plasma cell is called a . People with monoclonal gammopathy generally don't experience signs or symptoms. Copyright 2023 Haymarket Media, Inc. All Rights Reserved Some immunoglobulins can be abnormal and may be due to cancer. If serum protein electrophoresis is abnormal at any time during the follow-up, a referral should be made. Next-generation sequencing is being done now on a research basis but may soon be used in routine clinical practice. In these cases of light chain myeloma, serum test results may not show the characteristic increase of M protein (M spike), but there may be large amounts of monoclonal light chains in the urine. The lab will also treat the gel so that it only keeps . These symptoms could include the following: Some of the conditions that could be causing these symptoms are: No preparation is needed for the test. Accessed April 18, 2019. Multiple Myeloma: Diagnosis; 2018 Jul [cited 2019 Dec 10]; [about 3 screens]. Enter your information to receive occasional news and important updates! The serum immunofixation test is most often done with a blood sample. [9], In addition, immunofixation can be used to monitor therapy in plasma cell dyscrasias (ie, multiple myeloma and Waldenstrom macroglobulinemia). Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel. 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. [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. AskMayoExpert. Many subspecialists. This process is known as electrophoresis. SPEP is used to help diagnose and monitor a variety of different diseases or disorders that have abnormal proteins or protein levels. Further investigation will usually be needed to make a definitive diagnosis. You can also contact us directly if you need to. 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.
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