CBC often reveals a normochromic normocytic anemia. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. excess of an abnormal immunoglobulin called monoclonal protein (or M protein). Protein electrophoresis serum : Overview; [updated 2021 Aug 9; cited 2021 Aug 9]; [about 2 screens]. 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). 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. A concomitant measurement of the creatinine in the 24-hour urine sample for correction of sampling errors has been proposed. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. When the body produces abnormal antibodies, they are called monoclonal proteins, or M proteins. Clinical course and management of monoclonal gammopathy of undetermined significance. Affected patients have few bone lesions and few hematologic disturbances. Monoclonal gammopathy of undetermined significance (MGUS) care at Mayo Clinic. 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. Its not always obvious what high or low protein levels in the blood serum may mean. Immunofixation: Reference Range, Interpretation, Collection and Panels Some immunoglobulins can be abnormal and may be due to cancer. Next-Generation Sequencing (NGS). Madison (WI):University of Wisconsin Hospitals and Clinics Authority; c2021. A second screen is used to confirm positive test results. StatPearls. Typically, the monoclonal protein is discovered, and workup then ensues. Available from: Systemic Autoinflammatory Disease (SAID) Support [Internet]. bone pain. Immunofixation "fixes" certain proteins into place with antibodies and then washes away the others before staining them. Monoclonal protein is the output of myeloma cells in most people with myeloma. Save my name, email, and website in this browser for the next time I comment. You can also contact us directly if you need to. Immunofixation in CSF for the detection of oligoclonal bands is indicated every time there is suspicion for multiple sclerosis. This usually takes less than five minutes. How Is a Serum Immunofixation Test Done? Do You Need It? - WebMD These tests are done in conjunction with immunofixation for example, serum immunofixation electrophoresis (SIFE), which identifies immunoglobulins in blood samples. In some cases, the test is done with a urine sample. In Kelowna I had the week of review, and go out 2-3 mornings a week while in Chem and Hematology. Its a useful skill to maintain, as technologists especially those on off-shifts or at smaller sites may still collect through their career(s). Accessed April 18, 2019. 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). Share cases and questions with Physicians on Medscape consult. It can also detect changes in the ratio of kappa and lambda light chain production, which indicates an excess of abnormal plasma cells. Affected patients have only one tumor, with no other bone lesions and no urine or serum abnormalities. Myeloma is a cancer of plasma cells, a type of white blood cell (WBC) in the bone marrow that is responsible for making immunoglobulins. Skeletal lesions (e.g., lytic lesions, diffuse osteopenia, vertebral compression fractures) are present in 80 percent of patients. Mayo Clinic, Rochester, Minn. April 26, 2019. 2023 Healthline Media LLC. 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. There is less than 10 percent plasma cell involvement on bone marrow biopsy. 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. This content is owned by the AAFP. The net charge (positive or negative) and the size and shape of the protein commonly are used in differentiating various serum proteins.1. Alexandria (VA): American Society of Clinical Oncology; 20052019. Immunofixation detects monoclonal proteins in serum and urine Peripheral blood contains more than 20 percent plasma cells. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. Accessed April 18, 2019. Head over to share your story and tell us about it. It should be noted that immunoglobulins often can be found throughout the electrophoretic spectrum. 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. 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. Monoclonal gammopathy of undetermined significance. Platelets Small substances in your blood that help the blood to form a thickened mass (or blood clot) to help stop bleeding. An immunofixation blood test, also known as protein electrophoresis, measures certain proteins in the blood. Some. The next five components (globulins) are labeled alpha1, alpha2, beta1, beta2, and gamma. Is there a person or breakthrough we should celebrate? [Full Text]. Diagnostic Approach to Patients with an IgM Monoclonal Protein If serum protein electrophoresis is abnormal at any time during the follow-up, a referral should be made. Pruthi RK (expert opinion). Then it says: "The SPE pattern appears essentially unremarkable. Cawley LP, Minard BJ, Tourtellotte WW, et al. The presence of a suspected monoclonal can lead to further testing by immunofixation electrophoresis (IFE). Consequently, urine protein electrophoresis is recommended in all patients suspected of having a plasma cell dyscrasia.10. The beta fraction has two peaks labeled beta1 and beta2. 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). Monoclonal gammopathy of undetermined significance (MGUS). We've rounded up the best at-home kidney health test kits. Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. An apparent monoclonal protein on serum protein electrophoresis may or may not be a true monoclonal protein. Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. Other inflammatory conditions of the CNS can present with oligoclonal bands in CSF resulting from intrathecal production of antibodies. The band pattern is specific for certain diseases. [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. 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. Available from: Lab Tests Online [Internet]. This test is called serum protein electrophoresis (SPEP) test. 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. Your doctor tests your bone marrow to look for malignant plasma cells. The IFX test can also be used to study changes in the structure of normal. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. 2018 Dec 3. Posts: 33. On the left a serum protein electrophoresis (SPEP) of a patient with a monoclonal band in the gamma region is shown. The presence of M proteins can be a sign of a type of cancer called myeloma, or multiple myeloma. However, you shouldnt have a lot of protein in your urine. Medscape Drugs & Diseases. What does no monoclonal protein detected mean - DQKD Portland (ME): Maine Health; c2019. Blood. Low concentration of monoclonal immunoglobulins (LCMI) Heavy chain disease Suggested Additional Lab Testing For multiple myeloma: In addition to SPEP followed by immunofixation, quantitative. One pathologic reason which we covered at BCIT is a monoclonal gammopathy. [16]. Copyright 2023 American Academy of Family Physicians. Bone Marrow Tests. Sample size: Every drop of urine within 24 hours is included in the sample. Am J Clin Pathol. 24:1121-7. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019. 2019 May 23. Multiple Myeloma: Symptoms and Signs; 2016 Oct [cited 2019 Dec 10]; [about 3 screens]. The disorder occurs most commonly in older men. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. Each plasma cell produces one of five types of antibodies: IgG, IgA, IgM, IgE or IgD, and either kappa or lambda. Accessed April 18, 2019. How to get clearer test results on monoclonal antibodies Learn why immunohistochemistry is the gold standard in testing for certain diseases, including several cancers. Available from: National Cancer Institute [Internet]. Highly trained oncology social workersand nurses. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. 5 fractions are shown in this image: albumin, alpha-1 ( 1 ), alpha-2 ( 2 ), beta () and gamma (). Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. Immunofixation consists of an electrophoresis phase and a fixation phase. Imaging Tests. If all tests are normal, the pattern of follow-up in Figure 36 can be undertaken. Monoclonal Gammopathies | Johns Hopkins Medicine No monoclonal band is identified. Albumin, the major protein component of serum, is produced by the liver under normal physiologic conditions. 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. [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. Many subspecialists. The names of these subsets are based on the method that is used to separate and differentiate the various serum components. 2nd Ed, Kindle. Autoinflammatory vs. Autoimmune: What is the Difference? 135:1048-51. University of Rochester Medical Center [Internet]. [10]. Healthline Media does not provide medical advice, diagnosis, or treatment. Urine Immunofixation: Symptoms, Treatment, and More - WebMD All rights reserved. Burns also may result in a low albumin level. The gamma-globulin zone is decreased in hypogammaglobulinemia and agammaglobulinemia. Abnormalities in any of these tests should result in a referral to a hematologist-oncologist. Sometimes, however, the results of this examination can be confusing or difficult to interpret. 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. These measurements indicate the degree to which the myeloma cells in the marrow are affecting normal blood cell development. The information on this site should not be used as a substitute for professional medical care or advice. The precise cause of MGUS isn't known. Immunofixation electrophoretic techniques applied to identification of proteins in serum and cerebrospinal fluid. Ronald Hoffman, Leslie E. Silberstein, Sanford J. Shattil, Bruce Furie, Philip McGlave. If you log out, you will be required to enter your username and password the next time you visit. Bone marrow examination may be informative. 2016 Jan 27 [cited 2019 Dec 18]; 2016 (1):37-51. https://www.uptodate.com/contents/search. Because MGUS is not harmful, it doesn't need to be treated. Bird J, Behrens J, Westin J, et al. Fortunately, the cause of an abnormal curve is not always pathologic. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. Multiple Myeloma. To confirm the former and because of the latter, if there is a high index of clinical suspicion, immunofixation studies are required. All Rights Reserved. Instead, they only make light chains. [QxMD MEDLINE Link]. Serum is placed on a specific medium, and a charge is applied. 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We look forward to connecting with you. Urbancek S, Gascon P, Schwartz RA, Jacobson DR, Buxbaum JN, Bogdan CA. PDF Multiple Myeloma Early Detection, Diagnosis, and Staging In the interpretation of serum protein electrophoresis, most attention focuses on the gamma region, which is composed predominantly of antibodies of the IgG type. The remainder had hypogammaglobulinemia or a normal-appearing pattern. So when the Serum Protein Electrophoresis (SPEP) test shows a spike in M protein, this is a sign of MM. Tests are done to measure the levels of many different substances in the blood. 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. However, blood has several components. In: Ferri's Clinical Advisor 2019. These conditions should be promptly diagnosed and treated. Urine immunofixation uses electricity to push proteins from your urine sample through a kind of gel. Murray DL, Puig N, Kristinsson S, et al. Several subsets of serum protein electrophoresis are available.