2017 Dec 28. MGUS usually causes no problems. This website also contains material copyrighted by 3rd parties. These tests also can identify the specific protein type involved in your high blood protein levels. There is less than 10 percent plasma cell involvement on bone marrow biopsy. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. Want to view more content from Cancer Therapy Advisor? excess of an abnormal immunoglobulin called monoclonal protein (or M protein). Immunoglobulins, known as Igs, are a group of proteins that help protect your body from illness. Available from: National Cancer Institute [Internet]. Washington D.C.: American Association for Clinical Chemistry; c20012019. 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. The subgroups are: Measuring the proteins in each subgroup can help diagnose a variety of diseases. Serum free light chain testing provides complementary information to the two protein electrophoresis tests: SPEP and UPEP. Finally, isolated light chain bands, either kappa or lambda, represent more commonly pure kappa or lambda light chain gammopathies or, less commonly, immunoglobulin D (IgD) or immunoglobulin E (IgE) gammopathies. There are various types of these proteins that fight different types of infections. These include: You may need testing if you have symptoms of certain diseases, such as multiple myeloma, multiple sclerosis, malnutrition, or malabsorption. Urine immunofixation uses electricity to push proteins from your urine sample through a kind of gel. Complete Blood Count (CBC). Peripheral blood smear often shows RBCs in a stacked or rouleaux formation. In other cases, patients may have non-specific symptoms, meaning the discovery of a protein band in the serum . The lab will also treat the gel so that it only keeps . No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. 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. Merck Manual Professional Version. There are a number of reasons why a doctor may order this test. Healthcare providers treat the underlying cause of the immune response to help treat polyclonal gammopathy. 2021 Feb 1. This is serum. How is an immunofixation test interpreted? Urine IFE tests are often done if IFE blood test results were not normal. 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. Beta1 is composed mostly of transferrin, and beta2 contains beta-lipoprotein. The serum immunofixation test is most often done with a blood sample. Finally, the sample is washed to remove the proteins that do not precipitate and then stained, destained, and dried. Cancer.Net [Internet]. The "M" technically stands for "monoclonal," but M protein is often referred to as myeloma protein. It involves exposing serum placed in a special type of gel to an electric current. 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. [9]. Its a useful skill to maintain, as technologists especially those on off-shifts or at smaller sites may still collect through their career(s). Malignancy and acute inflammation (resulting from acute-phase reactants) can increase the alpha1-protein band. 11 (2):24. Malnutrition; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. 2019 Jun 20. Autoinflammatory vs. Autoimmune: What is the Difference? 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. [QxMD MEDLINE Link]. Hematocrit is a blood test that is used to determine if you have low levels of hemoglobin in your blood (a condition called anemia). Lahuerta JJ, Jimenez-Ubieto A, Paiva B, et al. If there's no disease progression, MGUS doesn't require treatment. 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. Serum protein electrophoresis (SPEP) is a laboratory technique thats used to determine the levels of some types of proteins in a blood sample. So when the Serum Protein Electrophoresis (SPEP) test shows a spike in M protein, this is a sign of MM. Monoclonal gammopathy of undetermined significance (MGUS) (adult). 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. Tests are done to measure the levels of many different substances in the blood. 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. Available from. Anemia, pancytopenia, hypercalcemia, and renal disease may be present. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: lymphoma; [cited 2019 Dec 10]; [about 3 screens]. Immunofixation to identify the M component as an IgM immunoglobulin with a quantitative IgM level greater than 3 g/dL. Learn more about laboratory tests, reference ranges, and understanding results. 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. When you arrive, a healthcare professional will simply use a needle to take a blood sample. 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. 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. 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. Abnormalities in any of these tests should result in a referral to a hematologist-oncologist. 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. 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. The various proteins in the body perform different functions. Medscape Drugs & Diseases. Join the BCIT conversation on social media. Advertising revenue supports our not-for-profit mission. Available from: National Multiple Sclerosis Society [Internet]. Affected patients have hyperviscosity and hypercellular bone marrow with extensive infiltration by lymphoplasma cells. 2011. Symptoms and Causes Diagnosis and Tests Management and Treatment Prevention Outlook / Prognosis Beaumont-Epinette MP, Moreau C, Besnard S, Latute F, Collet N, Sebillot M, et al. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process. Arch Pathol Lab Med. In most cases in which a monoclonal protein is present, it shows as a narrow band at the IgG lane in combination with a monoclonal band at the kappa or lambda lane. Inflammatory diseases include. There are several reasons a patients SPE curve could be abnormal. These tests are done in conjunction with immunofixation for example, serum immunofixation electrophoresis (SIFE), which identifies immunoglobulins in blood samples. When there is damage to the kidneys, other proteins, such as albumin, may also be present in the urine. The pattern of serum protein electrophoresis results depends on the fractions of two major types of protein: albumin and globulins. Blood Chemistry Tests. Thanks for helping me with this quality post. [Full Text]. Monoclonal gammopathies are conditions in which abnormal proteins are found in the blood. Are you a BCIT News insider? Monoclonal gammopathy of undetermined significance (MGUS). You can learn more about how we ensure our content is accurate and current by reading our. Medscape Drugs & Diseases. Red top tube for the collection of serum used. A total protein test can determine whether you have high blood protein. Detection of oligoclonal bands in cerebrospinal fluid by immunofixation electrophoresis. Plasma cell disorders. It involves exposing serum placed in a. 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. Image courtesy of Rush University. Some people may experience a rash or nerve problems, such as numbness or tingling. Copyright 2023 American Academy of Family Physicians. Since the expression levels of these genes and how mutations in them, if present, influence the behavior of the myeloma cells, these techniques may be helpful in better predicting treatment outcomes and developing new and improved targeted therapies. Pathol Biol (Paris). 147:22-42. 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. 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. 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. 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. On the contrary, a persistent monoclonal protein despite treatment is a sign of refractory disease. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. This abnormal protein is formed within your bone marrow, the soft, blood-producing tissue that fills in the center of most of your bones. The alpha1-protein fraction is comprised of alpha1-antitrypsin, thyroid-binding globulin, and transcortin. Among these other causes are Waldenstrms macroglobulinemia, solitary plasmacytoma, smoldering multiple myeloma, monoclonal gammopathy of undetermined significance, plasma cell leukemia, heavy chain disease, and amyloidosis.4,7, The quantity of M protein can help differentiate multiple myeloma from monoclonal gammopathy of undetermined significance. Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. 1 The term monoclonal gammopathy of undetermined significance (MGUS) was coined by Dr. Robert Kyle in 1978 to describe an asymptomatic plasma cell dyscrasia characterized by a . 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. 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. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: leukemia; [cited 2019 Dec 10]; [about 3 screens]. Available from: National Heart, Lung, and Blood Institute [Internet]. This content is owned by the AAFP. The LLS mission: Cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. Gainesville (FL): University of Florida Health; c2021. This whole (intact) immunoglobulin, made of the four chains, is usually too large to pass through the kidney. Goldman L, et al., eds. Available from: National Cancer Institute [Internet]. Immunoglobulin-related amyloidosis. Many subspecialists include serum protein electrophoresis screening in the initial evaluation for numerous clinical conditions. The IFX test can also be used to study changes in the structure of normal. Moving toward the negative portion of the gel (i.e., the negative electrode), the next peaks involve the alpha1 and alpha2 components. Medscape Drugs & Diseases. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Immunofixation reveals the heavy chain as alpha, gamma, or mu. If the monoclonal protein level decreases or is undetectable after chemotherapy, it might indicate a response to treatment. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019. Suspected multiple myeloma, Waldenstrms macroglobulinemia, primary amyloidosis, or related disorder, Unexplained peripheral neuropathy (not attributed to longstanding diabetes mellitus, toxin exposure, chemotherapy, etc. 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. What specimens can be used to perform an immunofixation test? SPEP is used to help diagnose and monitor a variety of different diseases or disorders that have abnormal proteins or protein levels. An additional point to consider is the size of the M-protein spike. 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. The most common type of myeloma is IgG kappa, occurring in approximately 52 % of patients. Immunofixationconsists of an electrophoresis phase and a fixation phase. Unattached, free light chains enter the blood and are excreted rapidly in the urine. The SFLC assay can detect abnormal levels of free light chains, which may be an indication of a plasma cell disorder. However, blood has several components. The output of monoclonal protein can vary from patient to patient. Malnutrition, significant liver disease, renal loss (e.g., in nephrotic syndrome), hormone therapy, and pregnancy may account for a low albumin level. It can also detect changes in the ratio of kappa and lambda light chain production, which indicates an excess of abnormal plasma cells. 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. Obtaining a precise diagnosis will help the doctor to: The results of blood tests that accompany periodic medical examinations may indicate the need for further evaluation for myeloma. Copyright 2017, 2013 Decision Support in Medicine, LLC. Genetic changes and environmental triggers appear to play a role. 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. Plasma protein levels display reasonably predictable changes in response to acute inflammation, malignancy, trauma, necrosis, infarction, burns, and chemical injury. [1] In the former, the serum is applied to an agarose gel, and the negatively charged serum proteins move toward the cathode under the influence of an electric current. 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 particular, when serum and urine protein electrophoresis results are negative, immunofixation is indicated as a more sensitive test if the clinical suspicion remains high. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Hematology: Basic Principles and Practice. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. This causes the different types of proteins to move and group together. Sample size: Every drop of urine within 24 hours is included in the sample. Morrow ES Jr. Allscripts EPSi. Fluorescence in situ hybridization (FISH) is a type of laboratory test that uses special dyes to identify mutations of specific chromosomes in cells. Chromosomal abnormalities play a crucial role in identifying cancerous cells and determining the risk of relapse. 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. Thus, it is most often present in the blood but not in the urine. (2015, August 12), Serum protein electrophoresis. Kaplan JS, Horowitz GL. Electrophoresis describes the migration of charged particles in an electric field, and their subsequent separation based on size and charge. 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. AskMayoExpert. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. The specimen can be serum, urine, or CSF. 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. My first week back in Chem was spent on the electrophoresis bench. To view unlimited content, log in or register for free. Your doctor tests your bone marrow to look for malignant plasma cells. Much of the clinical interest is focused on the gamma region of the serum protein spectrum because immunoglobulins migrate to this region. C-reactive protein (CRP) is located in the area between the beta and gamma components.1, Serum protein electrophoresis commonly is performed when multiple myeloma is suspected. For patients with MGUS and high risk for progression to multiple myeloma, surveillance should be performed at 6 months and then yearly thereafter. Share cases and questions with Physicians on Medscape consult. Protein electrophoresis immunofixation electrophoresis. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant. Characterized by a sharp peak in the beta-gamma region, monoclonal gammopathies involve increased production of immunoglobulins, or antibodies (IgA, IgG, IgM, etc.). That criteria is determined by a pathologist who reviews the bone marrow aspirate slides. You are being redirected to Monoclonal gammopathy is present in up to 8 percent of healthy geriatric patients.12 All patients with monoclonal gammopathy require further evaluation to determine the cause of the abnormality. In the interpretation of serum protein electrophoresis, most attention focuses on the gamma region, which is composed predominantly of antibodies of the IgG type. Skeletal lesions (e.g., lytic lesions, diffuse osteopenia, vertebral compression fractures) are present in 80 percent of patients. Imaging Tests. 2023 Healthline Media LLC. https://www.uptodate.com/contents/search. Monoclonal bands are usually seen in the zone but may be seen in proximity of the band or, rarely, in the 2 region. How is a serum sample collected for an immunofixation test? All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Rochester (NY): University of Rochester Medical Center; c2019. M-protein level is greater than 3 g per dL. What Is M Protein? After the needle is inserted, a small amount of blood will be collected into a test tube or vial. Instead, they only make light chains. Again, the lanes are broad and the transition to the lane borders is smooth. Monoclonal gammopathy of undetermined significance (MGUS). 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: UW Health [Internet]. Further investigation will usually be needed to make a definitive diagnosis. Haematologica. CSF immunofixation that does not reveal oligoclonal bands is also considered normal. 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. How is a CSF sample collected for an immunofixation test? 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).
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