what does no apparent monoclonal protein on serum electrophoresis mean

MGUS is usually detected by chance when you have a blood test for another condition. 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. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: lymphoma; [cited 2019 Dec 10]; [about 3 screens]. Immunofixation electrophoretic techniques applied to identification of proteins in serum and cerebrospinal fluid. Lahuerta JJ, Jimenez-Ubieto A, Paiva B, et al. Share cases and questions with Physicians on Medscape consult. A doctor may use the results to make a diagnosis or decide on a course of treatment. 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. In particular, when serum and urine protein electrophoresis results are negative, immunofixation is indicated as a more sensitive test if the clinical suspicion remains high. People with monoclonal gammopathy generally don't experience signs or symptoms. [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. The light chain is also called the Bence Jones protein, named for the doctor Henry Bence Jones who studied its characteristics. Join the BCIT conversation on social media. Shah D, Seiter K. Multiple myeloma. 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. Once a monoclonal gammopathy has been identified and a particular plasma cell proliferative disorder has been diagnosed, the quantification of the monoclonal protein is a good surrogate marker for monitoring the . There are two main types of proteins in the blood: albumin and globulin. correct number of peaks and protein values), the analyzer does a pretty good job of identifying each fraction. In many myeloma patients, the coordinated process of making and attaching light chains and heavy chains fails in the malignant plasma cells. For patients with MGUS and high risk for progression to multiple myeloma, surveillance should be performed at 6 months and then yearly thereafter. Affected patients have few bone lesions and few hematologic disturbances. Peripheral blood smear often shows RBC aggregates in a rouleaux formation. See additional information. See permissionsforcopyrightquestions and/or permission requests. This so-called acute-reaction protein pattern involves increases in fibrinogen, alpha1-antitrypsin, haptoglobin, ceruloplasmin, CRP, the C3 portion of complement, and alpha1 acid glycoprotein. (2015, August 12), Serum protein electrophoresis. Platelets Small substances in your blood that help the blood to form a thickened mass (or blood clot) to help stop bleeding. Serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP) are tests in which proteins in blood and urine samples are separated so that individual antibodies can be identified and quantified. Blood Cancer J. Fortunately, the cause of an abnormal curve is not always pathologic. When might mass spectrometry be used in place of immunofixation? Blood is collected in a tube with clot activator. Following my rotation in Anatomical Pathology, I spent one week on accessioning review and another three in Chemistry. Electrophoresis describes the migration of charged particles in an electric field, and their subsequent separation based on size and charge. How is a urine sample collected for an immunofixation test? 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. Globulins comprise a much smaller fraction of the total serum protein content. No abstract available. Serum protein electrophoresis (SPEP) is a laboratory technique thats used to determine the levels of some types of proteins in a blood sample. Home Decision Support in Medicine LabMed, Monoclonal gammopathy of unknown significance (MGUS), Low concentration of monoclonal immunoglobulins (LCMI). Monoclonal protein is the output of myeloma cells in most people with myeloma. Some immunoglobulins can be abnormal and may be due to cancer. How is a CSF sample collected for an immunofixation test? 2018 Sep 7. A second screen is used to confirm positive test results. A homogeneous spike-like peak in a focal region of the gamma-globulin zone indicates a monoclonal gammopathy. The following imaging tests are a very important part of the diagnosis, staging and management of myeloma: If you're diagnosed with myeloma, you may need to undergo more tests during or after treatment to see how themyeloma cells are responding to therapy. 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. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019. The Licensed Content is the property of and copyrighted by DSM. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests; [cited 2020 Jan 5]; [about 3 screens]. Cancer.Net [Internet]. Instead, they only make light chains. Clinical course and management of monoclonal gammopathy of undetermined significance. Proteins play many important roles, including providing energy for the body, rebuilding muscles, and supporting the immune system. Multiple Myeloma: Symptoms and Signs; 2016 Oct [cited 2019 Dec 10]; [about 3 screens]. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. Monoclonal gammopathies of undetermined significance. The most common type of myeloma is IgG kappa, occurring in approximately 52 % of patients. Affected patients have no M protein in their urine, no lytic bone lesions, no anemia, no hypercalcemia, and no renal disease. 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. When you arrive, a healthcare professional will simply use a needle to take a blood sample. 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. If the monoclonal protein level decreases or is undetectable after chemotherapy, it might indicate a response to treatment. Further investigation will usually be needed to make a definitive diagnosis. This abnormal protein is formed within your bone marrow, the soft, blood-producing tissue that fills in the center of most of your bones. 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. M-protein level is usually greater than 3 g per dL. These symptoms could include the following: Some of the conditions that could be causing these symptoms are: No preparation is needed for the test. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Is there something going on we should know about? The identification of a monoclonal gammopathy depends on serum and urine protein electrophoresis and immunoelectrophoresis (IFE) 1 and/or quantitative free light chain assays. 2015 Oct. 47 (6):564-9. 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. A serum thyroxine-binding globulin (TBG) level test is a blood test that measures the amount of TBG in your blood. [9], In addition, immunofixation can be used to monitor therapy in plasma cell dyscrasias (ie, multiple myeloma and Waldenstrom macroglobulinemia). Immunoglobulins are secreted by plasma cells, a type of white blood cell in the bone marrow, in response to infection and disease. [QxMD MEDLINE Link]. Protein electrophoresis immunofixation electrophoresis. ), 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. 9 (5):1895-1900. In fact, if no monoclonal component is detected by serum protein electrophoresis, immunofixation interpretation with bone marrow evaluation determines the type of response, stratifying. These include an elevated protein level, anemia and abnormalities in kidney function or calcium levels. 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 Available from: Lab Tests Online [Internet]. Available from: UF Health: University of Florida Health [Internet]. bone pain. A total protein test can determine whether you have high blood protein. Endoscopy vs. Colonoscopy: How Do They Differ? It can also detect changes in the ratio of kappa and lambda light chain production, which indicates an excess of abnormal plasma cells. The protein electrophoresis test is often used to find abnormal substances called M proteins. Murray DL, Puig N, Kristinsson S, et al. Serum free light chain testing provides complementary information to the two protein electrophoresis tests: SPEP and UPEP. Urine IFE tests are often done if IFE blood test results were not normal. IgA or some other type). You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. Urine Test. The beta fraction has two peaks labeled beta1 and beta2. Malabsorption; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. [QxMD MEDLINE Link]. The region is sometimes divided into 1 and 2, which would account for a sixth fraction. Available from. Washington D.C.: American Association for Clinical Chemistry; c20012019. Hematology: Basic Principles and Practice. High protein levels may be caused by many conditions. Save my name, email, and website in this browser for the next time I comment. Available from: Systemic Autoinflammatory Disease (SAID) Support [Internet]. 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. This usually takes less than five minutes. Available from: National Cancer Institute [Internet]. The presence of oligoclonal bands in CSF but not in the serum, given their intrathecal production, is helpful in the diagnosis of multiple sclerosis. Washington D.C.: American Association for Clinical Chemistry; c20012019. 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). 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. 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. Monoclonal gammopathy of undetermined significance (MGUS). This content does not have an Arabic version. Last medically reviewed on October 20, 2016, Proteins are found in the blood of healthy people. 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. Medscape Drugs & Diseases. Medscape Education, 20022007195-overviewDiseases & Conditions, encoded search term (Immunofixation) and Immunofixation, Fast Five Quiz: Key Aspects of Multiple Myeloma, Fast Five Quiz: Multiple Myeloma Management, Fast Five Quiz: Relapsed/Refractory Multiple Myeloma, From War-Torn Beirut to Myeloma Research in NY, Bispecific Antibody Provides Durable Remission in Myeloma, Pathology of Mantle Cell Lymphoma: Biopsies, Diagnostic Markers, and Options for Clinicians Treating This Disease, CAR T-Cell Therapy for Relapsed/Refractory Multiple Myeloma. It involves exposing serum placed in a. In addition, doctors stagemyeloma to help them decide on the best treatmentplan. Close more info about Monoclonal Protein on Serum Protein Electrophoresis (M Component), Metabolic Alkalosis: Arterial Blood pH Elevated with Increased Arterial pCO2. IgA, IgM, and sometimes IgG, along with complement proteins, also can be identified in the beta fraction. If all tests are normal, the pattern of follow-up in Figure 36 can be undertaken. what does no apparent monoclonal protein on serum electrophoresis mean. A polyclonal gammopathy is characterized by a broad diffuse band with one or more heavy chains and kappa and lambda light chains.7, Once a monoclonal gammopathy is identified by serum protein electrophoresis, multiple myeloma must be differentiated from other causes of this type of gammopathy. Urbancek S, Gascon P, Schwartz RA, Jacobson DR, Buxbaum JN, Bogdan CA. Posts: 33. 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. Typically, the monoclonal protein is discovered, and workup then ensues. Monoclonal gammopathy of undetermined significance. Hematocrit is a blood test that is used to determine if you have low levels of hemoglobin in your blood (a condition called anemia). Genetic changes and environmental triggers appear to play a role. These proteins can also be referred to as an M-spike, monoclonal immunoglobulin, or paraprotein. The most common conditions in the differential diagnosis of polyclonal gammopathy are listed in Table 3.8,9, An M protein is characterized by the presence of a sharp, well-defined band with a single heavy chain and a similar band with a kappa or lambda light chain. Your doctor tests your bone marrow to look for malignant plasma cells. In addition, a beta2 microglobulin test, a CRP test, and a 24-hour urine collection for electrophoresis and immunofixation should be performed. The presence of a suspected monoclonal can lead to further testing by immunofixation electrophoresis (IFE). Visual examination of electrophoretic patterns by a pathologist is the most sensitive method of detecting monoclonal proteins since small bands may be obscured in densitometric scans. There are several reasons a patients SPE curve could be abnormal. 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. [Full Text]. Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. Next-Generation Sequencing (NGS). 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). [Full Text]. Cytogenetic Analysis. 2015 May. Several subsets of serum protein electrophoresis are available. Monoclonal proteins can be either intact monoclonal immunoglobulins or immunoglobulin light chains (Bence Jones proteins) found in the blood and/or urine. Rajhumar SV. Available from: National Cancer Institute [Internet]. Its not always obvious what high or low protein levels in the blood serum may mean. Plasma protein levels display reasonably predictable changes in response to acute inflammation, malignancy, trauma, necrosis, infarction, burns, and chemical injury. Among these, the committee stated that in the detection of monoclonal immunoglobulins, intact light-chain matrix-assisted laser desorption/ionization-time-of-flight (MALDI-TOF) mass spectrometry can be used in lieu of immunofixation in patient clinical assessments and in assessing clinical trial patients. This whole (intact) immunoglobulin, made of the four chains, is usually too large to pass through the kidney. Exp Ther Med. Healthcare providers treat the underlying cause of the immune response to help treat polyclonal gammopathy. What is the clinical application of an immunofixation test? 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. The method can be used to examine specific proteins in the blood, urine, and other body fluids. Copyright 2023 American Academy of Family Physicians. 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. 5th. The alpha1-protein fraction is comprised of alpha1-antitrypsin, thyroid-binding globulin, and transcortin. A decreased alpha1-protein band may occur because of alpha1-antitrypsin deficiency or decreased production of the globulin as a result of liver disease. Serum protein electrophoresis is an inexpensive, easy-to-perform screening procedure for initial identification of monoclonal bands. Factors that increase your risk of developing MGUS include: Each year about 1% of people with MGUS go on to develop certain types of blood cancers or other serious diseases such as: Other complications associated with MGUS include bone fractures, blood clots and kidney problems. 133 (25):2664-8. Monoclonal gammopathy of undetermined significance (MGUS) care at Mayo Clinic. Tests are done to measure the levels of many different substances in the blood. In blood cancers such as myeloma, the 'M' in 'M protein' stands for monoclonal. 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 gamma-globulin zone is decreased in hypogammaglobulinemia and agammaglobulinemia. A hair strand drug test can be used to detect drugs used over the past 90 days. Seiter K, Ponce D. Waldenstrom macroglobulinemia. Advertising revenue supports our not-for-profit mission. Gainesville (FL): University of Florida Health; c2021. 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. It should be noted that immunoglobulins often can be found throughout the electrophoretic spectrum. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: multiple myeloma; [cited 2019 Dec 10]; [about 3 screens]. The immunoelectrophoresis-serum test is used to. 1976. When the body produces abnormal antibodies, they are called monoclonal proteins, or M proteins. M-protein level is greater than 3 g per dL. Testing a 24-hour urine sample allows for an accurate measurement of the level of kidney function and can indicate possible kidney damage from myeloma. Some people experience mild pain when the needle is inserted. Accessed April 18, 2019. It measures the amount of two kinds of protein in your body, albumin and globulin. 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. In some patients, the myeloma cells do not make a complete monoclonal immunoglobulin molecule with two heavy and two light chains. Immunoglobulin-related amyloidosis. An immunofixation blood test, also known as protein electrophoresis, measures certain proteins in the blood. In some cases, all the lanes are homogeneously darkened to the same degree. [12] an additional assay for the identification of IgD or IgE must be performed. You may feel a little sting when the needle goes in or out. Given the dismal impact on prognosis in the latter scenario, This allows them to be measured and analyzed individually. 11 (2):24. 24:1121-7. Serum is placed on a specific medium, and a charge is applied. As denoted in the normal curve above, antibodies are primarily found in the fraction. Profile Information: Reflex Test: 2016 Jan 27 [cited 2019 Dec 18]; 2016 (1):37-51. Morrow ES Jr. Allscripts EPSi. To use the sharing features on this page, please enable JavaScript. The disorder occurs most commonly in older men. [QxMD MEDLINE Link]. Health Encyclopedia: Immunofixation (Blood); [cited 2019 Dec 10]; [about 2 screens]. Your results will show that your protein levels are in the normal range, too high, or too low. Sasson SC, McGill K, Wienholt L, Carr A, Brown DA, Kelleher AD, et al. Red top tube for the collection of serum used. Peripheral blood contains more than 20 percent plasma cells. Blood appears to be a single substance to the naked eye. Further separation of protein subtypes is achieved by staining with an immunologically active agent, which results in immunofluorescence and immunofixation. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process, and they usually are associated with nonmalignant conditions. Sample: Serum (whole blood or plasma is inappropriate, as fibrinogen may alter the results), Sample: 24-hour urine collection, concentrated. To view unlimited content, log in or register for free. In the interpretation of serum protein electrophoresis, most attention focuses on the gamma region, which is composed predominantly of antibodies of the IgG type. 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. This website also contains material copyrighted by 3rd parties. Clin Chem. Thanks for helping me with this quality post. CBC often reveals a normochromic normocytic anemia. Proteins play many important roles, including providing energy for the body, rebuilding muscles, and supporting the immune system. Moving toward the negative portion of the gel (i.e., the negative electrode), the next peaks involve the alpha1 and alpha2 components. You can learn more about how we ensure our content is accurate and current by reading our. Complete Blood Count (CBC). University of Rochester Medical Center [Internet]. Your doctor may recommend SPEP if you are experiencing symptoms of a condition affecting the proteins in your blood serum. 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. Another test, calledimmunofixation or immunoelectrophoresis, is used to determine the exact type ofabnormal antibody (IgG. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Consequently, urine protein electrophoresis is recommended in all patients suspected of having a plasma cell dyscrasia.10. Unattached, free light chains enter the blood and are excreted rapidly in the urine. The subsets of these proteins and their relative quantity are the primary focus of the interpretation of serum protein electrophoresis.1,3. Monoclonal gammopathies are conditions in which abnormal proteins are found in the blood. Each plasma cell produces one of five types of antibodies: IgG, IgA, IgM, IgE or IgD, and either kappa or lambda. Immunofixationconsists of an electrophoresis phase and a fixation phase. San Francisco: Said Support; c2013-2016. [9]. Blood. Flow Cytometry. Burns also may result in a low albumin level. Mayo Clinic, Rochester, Minn. April 26, 2019. 2019 Jun 20. A monoclonal spike (M spike or paraprotein) on serum protein electrophoresis (SPEP) is a frequent finding in the general population and typically is pathognomonic of an asymptomatic, premalignant condition called monoclonal gammopathy of undetermined significance (MGUS). This is a normal serum protein electrophoresis (SPE) pattern; also listed are a few of the proteins associated with each fraction. Retrieved from, Understanding serum protein electrophoresis, What abnormal results for SPEP test may mean, How test results may be used to decide future care, urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=protein_electrophoresis_serum, labtestsonline.org/understanding/analytes/electrophoresis, Serum Thyroxine-Binding Globulin (TBG) Level Test, Everything You Should Know About a Hair Strand Drug Test, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI. 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. Sign-upto receive the latest news on BCIT. Diagnosis requires 10 to 15 percent plasma cell involvement on bone marrow biopsy. Much of the clinical interest is focused on the gamma region of the serum protein spectrum because immunoglobulins migrate to this region.
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