what does no apparent monoclonal protein on serum electrophoresis mean

The monoclonal band is seen in: Multiple myelomas show in 99 % of the patients in serum and urine. A polyclonal immunoglobulin pattern in the serum or urine immunofixation is considered to be nonspecific. There are various types of these proteins that fight different types of infections. 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. When there is damage to the kidneys, other proteins, such as albumin, may also be present in the urine. In blood cancers such as myeloma, the 'M' in 'M protein' stands for monoclonal. 95:2126-33. Urbancek S, Gascon P, Schwartz RA, Jacobson DR, Buxbaum JN, Bogdan CA. Your doctor can use it to confirm certain diagnoses. All rights reserved. Immunoglobulins, known as Igs, are a group of proteins that help protect your body from illness. 2019 Jan. [QxMD MEDLINE Link]. Accessed April 18, 2019. 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. 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. A second screen is used to confirm positive test results. It can also detect changes in the ratio of kappa and lambda light chain production, which indicates an excess of abnormal plasma cells. If all tests are normal, the pattern of follow-up in Figure 36 can be undertaken. 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 . This is a normal serum protein electrophoresis (SPE) pattern; also listed are a few of the proteins associated with each fraction. Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. The specimen can be serum, urine, or CSF. The five groups of proteins usually considered during an SPEP test are: Electrophoresis is a lab technique used to separate groups of proteins in blood serum. On a computer screen, these proteins form a pattern of bands. If abnormal, the curve may be delineated in the wrong location(s) and should be fixed before the result is filed. excess of an abnormal immunoglobulin called monoclonal protein (or M protein). Ferri FF. The serum immunofixation test is most often done with a blood sample. There is less than 10 percent plasma cell involvement on bone marrow biopsy. It's easier to check your kidney health at home now more than ever. Protein Electrophoresis, Immunofixation Electrophoresis; [updated 2019 Oct 25; cited 2019 Dec 10]; [about 2 screens]. The disorder occurs most commonly in older men. Role of urine immunofixation in the complete response assessment of MM patients other than light-chain-only disease. Are you a BCIT News insider? IgA, IgM, and sometimes IgG, along with complement proteins, also can be identified in the beta fraction. These conditions should be promptly diagnosed and treated. Beaumont-Epinette MP, Moreau C, Besnard S, Latute F, Collet N, Sebillot M, et al. Lahuerta JJ, Jimenez-Ubieto A, Paiva B, et al. This can help the doctor decide how well therapies and medicines are working. https://www.uptodate.com/contents/search. The identification of a monoclonal immunoglobulin is helpful in the diagnosis of the following conditions On the left a serum protein electrophoresis (SPEP) of a patient with a monoclonal band in the gamma region is shown. M-protein level is greater than 3 g per dL. Available from: https://ufhealth.org/protein-electrophoresis-serum. Yet, every person's myeloma is unique. Washington D.C.: American Association for Clinical Chemistry; c20012019. They have a number of roles: Too much or too little protein can cause problems. 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. Available from: Lab Tests Online [Internet]. 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. Philadelphia, PA, USA: Elsevier Churchill Livingstone; 2008. chapter 87. 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. Definitive diagnosis of multiple myeloma requires 10 to 15 percent plasma cell involvement as determined by bone marrow biopsy. Available from: National Cancer Institute [Internet]. Definition. Any one or more of the following myeloma-defining events: Evidence of end-organ damage that can be attributed to the disease: (CRAB criteria), Clonal plasma cells in the bone marrow 60% with or without CRAB, Ratio of involved/uninvolved serum free light chain ratio 100 (involved free light chain levels must be 100mg/L), One or more focal lesions found on MRI studies (at least 5 mm in size), Bone/skeletal survey (x-rays of all the bones in the body), Whole body low-dose computed tomography (CT) scan, Positron emission tomography and computed tomography (PET-CT) scan, Download or order The Leukemia & Lymphoma Society's free booklets. Suspected multiple myeloma, Waldenstrms macroglobulinemia, primary amyloidosis, or related disorder, Unexplained peripheral neuropathy (not attributed to longstanding diabetes mellitus, toxin exposure, chemotherapy, etc. IgA or IgM bands are less common. Levels of albumin are increased in patients with a relative reduction in serum water (e.g., dehydration). It may also depend on the unique patterns made by the proteins. The identification of a monoclonal gammopathy depends on serum and urine protein electrophoresis and immunoelectrophoresis (IFE) 1 and/or quantitative free light chain assays. 1 It's called a monoclonal . Monoclonal bands are usually seen in the zone but may be seen in proximity of the band or, rarely, in the 2 region. 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. It involves exposing serum placed in a. Because MGUS is not harmful, it doesn't need to be treated. Further separation of protein subtypes is achieved by staining with an immunologically active agent, which results in immunofluorescence and immunofixation. Bird J, Behrens J, Westin J, et al. Rochester (NY): University of Rochester Medical Center; c2019. 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. Monoclonal gammopathy of undetermined significance (MGUS). 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. Blood is collected in a tube with clot activator. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. These symptoms could include the following: Some of the conditions that could be causing these symptoms are: No preparation is needed for the test. MGUS is usually detected by chance when you have a blood test for another condition. Monoclonal antibodies could be used as myeloma treatments and can be identified by serum protein electrophoresis and immunofixation electrophoresis. Its a useful skill to maintain, as technologists especially those on off-shifts or at smaller sites may still collect through their career(s). A total protein test can determine whether you have high blood protein. Fanning SR, Hussein MA. Kyle RA, Durie BG, Rajkumar SV, et al. Haematologica. Evol Med Public Health. Murray DL, Puig N, Kristinsson S, et al. Hemoglobin is a substance in your red blood cells (blood cells that carry oxygen through your body) that carries oxygen from your lungs to the tissues in your body. Electrophoresis is not usually used by itself to diagnose a disease. In: Ferri's Clinical Advisor 2019. Efficacy and outcome of autologous transplantation in rare myelomas. [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. 2019 Jun 20. John C Leighton, Jr, MD, FACP Clinical Associate Professor, Jefferson Medical College of Thomas Jefferson University; Chief, Division of Medical Oncology, Jeanes Hospital; Associate Director, Associate Chief, Divisions of Hematology/Medical Oncology, Albert Einstein Cancer Center; Associate Member Kimmel Cancer Center, Thomas Jefferson Hospital The following table shows what most labs would consider normal results for SPEP testing. Plasma protein levels display reasonably predictable changes in response to acute inflammation, malignancy, trauma, necrosis, infarction, burns, and chemical injury. If serum protein electrophoresis is abnormal at any time during the follow-up, a referral should be made. 5th. We want you to take advantage of everything Cancer Therapy Advisor has to offer. Kaplan JS, Horowitz GL. All Rights Reserved. This content is owned by the AAFP. All of these measurements provide information about the extent of the disease and are useful for monitoring response to treatment. There are several reasons a patients SPE curve could be abnormal. A serum free light chain ratio is indicated in the case of a negative immunofixation result when the suspicion for multiple myeloma is still high. Alexandria (VA): American Society of Clinical Oncology; 20052019. Flow Cytometry. This test measures the numbers of red blood cells, white blood cells and platelets in the blood. 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. 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. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. Diagnosis is often done with a lab test called electrophoresis. National Multiple Sclerosis Society; MS Symptoms; [cited 2019 Dec 18]; [about 3 screens]. 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. 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. Yang G, Geng C, Chen W. Clinical characteristics of a group of patients with multiple myeloma who had two different light chains by immunofixation electrophoresis: A retrospective study from a single center. Monoclonal gammopathy of undetermined significance. 9 (5):1895-1900. Platelets Small substances in your blood that help the blood to form a thickened mass (or blood clot) to help stop bleeding. Some people experience mild pain when the needle is inserted. [Internet]. Its not always obvious what high or low protein levels in the blood serum may mean. [QxMD MEDLINE Link]. Available from: National Cancer Institute [Internet]. Dimopoulos M, Kyle R, Fermand JP, et al. The presence of oligoclonal bands in CSF but not in the serum, given their intrathecal production, is helpful in the diagnosis of multiple sclerosis. Hematocrit is a blood test that is used to determine if you have low levels of hemoglobin in your blood (a condition called anemia). Also, the level of protein being excreted in the urine and the amount of light chains can be measured. Portland (ME): Maine Health; c2019. One pathologic reason which we covered at BCIT is a monoclonal gammopathy. 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. [9]. 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. Each plasma cell produces one of five types of antibodies: IgG, IgA, IgM, IgE or IgD, and either kappa or lambda. We look forward to connecting with you. The test separates these proteins into subgroups based on their size and electrical charge. Plasma cell disorders. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. On the contrary, a persistent monoclonal protein despite treatment is a sign of refractory disease. Washington D.C.: American Association for Clinical Chemistry; c20012019. This test is called serum protein electrophoresis (SPEP) test. The Licensed Content is the property of and copyrighted by DSM. How is a CSF sample collected for an immunofixation test? 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 135:1048-51. Accessed April 18, 2019. This means that high or low levels of the five protein types examined during the test can point to different illnesses. [QxMD MEDLINE Link]. The region is sometimes divided into 1 and 2, which would account for a sixth fraction. Image courtesy of Rush University. All rights reserved. An M-protein spike of greater than 2.5 g per dL should be assessed with a metastatic bone survey that includes a single view of the humeri and femurs. 1998. Goldman L, et al., eds. Among 161 patients in whom both serum and urine demonstrated positive results for monoclonal protein and who were, posttreatment, negative for serum immunofixation, just 3 (1.9%) displayed positive urine immunofixation. An endoscopy is used in a wide range of testing throughout the body. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Genetic changes and environmental triggers appear to play a role. Enter your information to receive occasional news and important updates! Peripheral blood smear often shows RBCs in a stacked or rouleaux formation. The M protein has an incomplete heavy chain and no light chain. These measurements indicate the degree to which the myeloma cells in the marrow are affecting normal blood cell development. 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. URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. Youve read {{metering-count}} of {{metering-total}} articles this month. Home Decision Support in Medicine LabMed, Monoclonal gammopathy of unknown significance (MGUS), Low concentration of monoclonal immunoglobulins (LCMI). [Full Text]. Available from: National Heart, Lung, and Blood Institute [Internet]. The albumin band represents the largest protein component of human serum. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. The alpha1-protein fraction is comprised of alpha1-antitrypsin, thyroid-binding globulin, and transcortin. Comparison of the Freelite serum free light chain (SFLC) assay with serum and urine electrophoresis/immunofixation and the N Latex FLC assay. The Leukemia & Lymphoma Society is a 501(c)(3) organization, and all monetary donations are tax deductible to the fullest extent allowed by tax laws. You can also contact us directly if you need to. If Waldenstrms macroglobulinemia or other lymphoproliferative process is suspected, an abdominal computed tomographic scan and bone marrow aspiration and biopsy should be performed. Albumin, the major protein component of serum, is produced by the liver under normal physiologic conditions. 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. Accessed April 18, 2019. Immunoglobulin-related amyloidosis. Fortunately, the cause of an abnormal curve is not always pathologic. bone pain. Save my name, email, and website in this browser for the next time I comment. Medscape Drugs & Diseases. [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. Mayo Clinic, Rochester, Minn. Feb. 8, 2019. [20]. Affected patients have only one tumor, with no other bone lesions and no urine or serum abnormalities. Ramakrishnan N, Jialal I. Bence-Jones Protein. Blood appears to be a single substance to the naked eye. Reference Range Immunofixation consists of an electrophoresis phase and a fixation phase. Serum protein electrophoresis is the easiest means of excluding the presence of a monoclonal protein and can detect bands of 0.5 gm/dL or less. 2nd Ed, Kindle. If the curve is relatively normal (e.g. 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. [Full Text]. Protein electrophoresis alone is not considered an adequate screen for monoclonal gammopathies. 5 fractions are shown in this image: albumin, alpha-1 (1), alpha-2 (2), beta () and gamma (). Monoclonal protein (M protein) levels can be measured in blood and/or urine samples,and these levels generally correlate with the extent of the myeloma. 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). There are two main types of proteins in the blood: albumin and globulin. 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. Waldenstrom macroglobulinemia always shows a serum IgM-type monoclonal band. 2021 Feb 1. This abnormal protein is formed within your bone marrow, the soft, blood-producing tissue that fills in the center of most of your bones. Urine IFE tests are often done if IFE blood test results were not normal. Fluorescence in situ hybridization (FISH) is a type of laboratory test that uses special dyes to identify mutations of specific chromosomes in cells. Monoclonal gammopathy of undetermined significance (MGUS) (adult). [7], The identification of oligoclonal bands in CSF is helpful in the diagnosis of multiple sclerosis. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. The gamma-globulin zone is decreased in hypogammaglobulinemia and agammaglobulinemia. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Highly trained oncology social workersand nurses. Immunofixationconsists of an electrophoresis phase and a fixation phase. If you have questions about your results, talk to your health care provider. 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. The disorder occurs most commonly in older men. 22:1262-8. [QxMD MEDLINE Link]. [14], Mass spectrometry is sometimes employed in place of immunofixation because of the latters limitations, such as in the detection of low-level disease. These tests are performed when the IFE blood test doesn't give . What are considerations regarding immunofixation results in multiple myeloma, and what are the limitations of a 24-hour concentrated urine sample for immunofixation testing? cancer cells lead to abnormal immunoglobulins; their build-up negatively affects the formation and function of normal blood cells, the kidneys, and neurologic state, amongst other things. For patients with MGUS and high risk for progression to multiple myeloma, surveillance should be performed at 6 months and then yearly thereafter. 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). Most patients with untreated myeloma have a monoclonal immunoglobulin spike in serum, urine, or both. Accessed April 18, 2019. Medscape Drugs & Diseases. It measures the amount of two kinds of protein in your body, albumin and globulin. 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. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 25th ed. Health Encyclopedia: Immunofixation (Blood); [cited 2019 Dec 10]; [about 2 screens]. Immunoglobulins are secreted by plasma cells, a type of white blood cell in the bone marrow, in response to infection and disease. If there are not CRAB signs and/or symptoms, 60% plasma cells in the bone marrow indicates a diagnosis. 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 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. 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. (2015, August 21). Globulins comprise a much smaller fraction of the total serum protein content. Many subspecialists include serum protein electrophoresis screening in the initial evaluation for numerous clinical conditions. 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. 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 Leukemia & Lymphoma Society (LLS) is a global leader in the fight against blood cancer. If there's no disease progression, MGUS doesn't require treatment. What specimens can be used to perform an immunofixation test? Both types of blood cells (red and white) and platelets are solids. In fact, if no monoclonal component is detected by serum protein electrophoresis, immunofixation interpretation with bone marrow evaluation determines the type of response, stratifying. Copyright 2023 American Academy of Family Physicians. 109:585-8. 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. 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. Immunofixation "fixes" certain proteins into place with antibodies and then washes away the others before staining them. Then it says: "The SPE pattern appears essentially unremarkable.

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