what does no apparent monoclonal protein on serum electrophoresis mean
1998. Therefore, the International Myeloma Working Group Mass Spectrometry Committee created a set of recommendations for the evaluation of monoclonal proteins in multiple myeloma and related disorders, using mass spectrometry. An endoscopy is used in a wide range of testing throughout the body. If the monoclonal protein level decreases or is undetectable after chemotherapy, it might indicate a response to treatment. This content is owned by the AAFP. 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. Is there a person or breakthrough we should celebrate? Cavuoti D, Baskin L, Jialal I. There is very little risk to having a blood test. The net charge (positive or negative) and the size and shape of the protein commonly are used in differentiating various serum proteins.1. 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. Your results will show that your protein levels are in the normal range, too high, or too low. The LLS mission: Cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. The light chain is also called the Bence Jones protein, named for the doctor Henry Bence Jones who studied its characteristics. Malnutrition, significant liver disease, renal loss (e.g., in nephrotic syndrome), hormone therapy, and pregnancy may account for a low albumin level. Shah D, Seiter K. Multiple myeloma. Immunofixation to identify the M component as an IgM immunoglobulin with a quantitative IgM level greater than 3 g/dL. [10, 17], A 24-hour concentrated urine sample is appropriate for urine immunofixation. [Internet]. Pathol Biol (Paris). The next five components (globulins) are labeled alpha1, alpha2, beta1, beta2, and gamma. CBC often reveals a normochromic normocytic anemia. No abstract available. Immunofixation detects monoclonal proteins in serum and urine Please login or register first to view this content. Multiple Myeloma: Symptoms and Signs; 2016 Oct [cited 2019 Dec 10]; [about 3 screens]. 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. This content does not have an Arabic version. Bird J, Behrens J, Westin J, et al. 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. The examination also should be considered in other red flag situations (Table 1).24, If the examination is normal but multiple myeloma, Waldenstrms macroglobulinemia, primary amyloidosis, or a related disorder still is suspected, immunofixation also should be performed because this technique may be more sensitive in identifying a small monoclonal (M) protein.5. Available from: National Cancer Institute [Internet]. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. 2018 Dec 3. Highly trained oncology social workersand nurses. [QxMD MEDLINE Link]. Immunofixation tests can also be done in urine. Cytogenetic Analysis. Protein Electrophoresis questions. Tests are done to measure the levels of many different substances in the blood. There are five types of heavy chains, and each type is represented by a specific letter: IgG, IgA, IgD, IgE and IgM. This means that high or low levels of the five protein types examined during the test can point to different illnesses. If the curve is relatively normal (e.g. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2019. Bone marrow biopsy may be useful to show aggregates of plasma cells in focal or diffuse patterns. The beta fraction has two peaks labeled beta1 and beta2. M protein is made by abnormal plasma cells. Characteristic differentiating features of the monoclonal gammopathies are listed in Table 4.7, In some patients with a plasma cell dyscrasia, serum protein electrophoresis may be normal because the complete monoclonal immunoglobulin is absent or is present at a very low level.7 In one series,6 serum protein electrophoresis showed a spike or localized band in only 82 percent of patients with multiple myeloma. Health Encyclopedia: Immunofixation (Blood); [cited 2019 Dec 10]; [about 2 screens]. Copyright 2005 by the American Academy of Family Physicians. Washington D.C.: American Association for Clinical Chemistry; c20012019. Reference Range Immunofixation consists of an electrophoresis phase and a fixation phase. Monoclonal gammopathy of undetermined significance. 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. When is an immunofixation test indicated? The pattern of serum protein electrophoresis results depends on the fractions of two major types of protein: albumin and globulins. Typically present in low amounts, conditions such as multiple myeloma and Waldenstrms macroglobulinemia show proliferation of abnormal or cancerous plasma cells. The M protein has an incomplete heavy chain and no light chain. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. In zone electrophoresis, for example, different protein subtypes are placed in separate physical locations on a gel made from agar, cellulose, or other plant material.2,3 The proteins are stained, and their densities are calculated electronically to provide graphical data on the absolute and relative amounts of the various proteins. [12] an additional assay for the identification of IgD or IgE must be performed. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process. Want to view more content from Cancer Therapy Advisor? 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. [Full Text]. Hematology: Basic Principles and Practice. Medscape Drugs & Diseases. Serum protein electrophoresis (SPEP) is a laboratory technique thats used to determine the levels of some types of proteins in a blood sample. It may also depend on the unique patterns made by the proteins. Immune Thrombocytopenia Purpura (ITP): What helps? Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. Thanks for helping me with this quality post. A malignant plasma cell is called a . 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. High blood protein When to see a doctor - Mayo Clinic ), 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. Mayo Clinic does not endorse companies or products. If these examinations are normal, serum protein electrophoresis should be repeated in three to six months; if that examination is normal, serum protein electrophoresis should be repeated annually. 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). Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: lymphoma; [cited 2019 Dec 10]; [about 3 screens]. Making sense of serum protein bands. Blood Cancer J. Healthline Media does not provide medical advice, diagnosis, or treatment. Profile Information: Reflex Test: The names of these subsets are based on the method that is used to separate and differentiate the various serum components. How to get clearer test results on monoclonal antibodies 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. Rajhumar SV. Immunofixation in CSF for the detection of oligoclonal bands is indicated every time there is suspicion for multiple sclerosis. All rights reserved. The alpha1-protein fraction is comprised of alpha1-antitrypsin, thyroid-binding globulin, and transcortin. Immunofixation "fixes" certain proteins into place with antibodies and then washes away the others before staining them. Copyright 2017, 2013 Decision Support in Medicine, LLC. The Leukemia & Lymphoma Society (LLS) is a global leader in the fight against blood cancer. excess of an abnormal immunoglobulin called monoclonal protein (or M protein). 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. Dimopoulos M, Kyle R, Fermand JP, et al. To use the sharing features on this page, please enable JavaScript. A small number of patients with myeloma have either oligosecretory disease, inwhich the detectable level of monoclonal protein is low, or nonsecretory disease,in which no monoclonal protein can be detected. Blood. Monoclonal gammopathies are conditions in which abnormal proteins are found in the blood. Philadelphia, PA, USA: Elsevier Churchill Livingstone; 2008. chapter 87. Medscape Drugs & Diseases. When these are removed, a liquid is left behind. 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. Immunofixation consists of an electrophoresis phase and a fixation phase. It involves exposing serum placed in a special type of gel to an electric current. Here are my blood test results for "Interpretation" part. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Other inflammatory conditions of the CNS can present with oligoclonal bands in CSF resulting from intrathecal production of antibodies. Although this spike is usually greater than 3 g per dL in patients with multiple myeloma, up to one fifth of patients with this tumor may have an M-protein spike of less than 1 g per dL.10 Hypogammaglobulinemia on serum protein electrophoresis occurs in about 10 percent of patients with multiple myeloma who do not have a serum M-protein spike.11 Most of these patients have a large amount of Bence Jones protein (monoclonal free kappa or lambda chain) in their urine.11 Thus, the size of the M-protein spike is not helpful in excluding multiple myeloma. [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. All Rights Reserved. If there are not CRAB signs and/or symptoms, 60% plasma cells in the bone marrow indicates a diagnosis. Available from: National Multiple Sclerosis Society [Internet]. The lab will also treat the gel so that it only keeps . Characterized by a sharp peak in the beta-gamma region, monoclonal gammopathies involve increased production of immunoglobulins, or antibodies (IgA, IgG, IgM, etc.). 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. These include an elevated protein level, anemia and abnormalities in kidney function or calcium levels. A doctor may use the results to make a diagnosis or decide on a course of treatment. 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). 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. Rajhumar SV. Your story might just end up on BCIT News. One of the best ways to get a better sense of the SPEP test is to look at each word in the name: Serum is the liquid part of your blood. 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. Finally, when several bands with sharp borders are seen after immunofixation in cerebrospinal fluid (CSF) but not in serum, the result is reported as positive for oligoclonal bands. [Full Text]. Proteins play many important roles, including providing energy for the body, rebuilding muscles, and supporting the immune system. High amounts of M protein in a person's blood or urine may be a sign they have multiple myeloma but the presence of M proteins could also indicate other types of plasma cell tumors. M-protein level is usually greater than 3 g per dL. The "M" technically stands for "monoclonal," but M protein is often referred to as myeloma protein. Accessed April 18, 2019. Immunoglobulins, known as Igs, are a group of proteins that help protect your body from illness. 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. Symptoms and Causes Diagnosis and Tests Management and Treatment Prevention Outlook / Prognosis The following table shows what most labs would consider normal results for SPEP testing. Posts: 33. [Full Text]. The immunoelectrophoresis-serum test is used to. 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. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. Also, the level of protein being excreted in the urine and the amount of light chains can be measured. How Is a Serum Immunofixation Test Done? Do You Need It? - WebMD Under the PE Value it says: "SPE1". Monoclonal gammopathies of undetermined significance. The test may also be performed again in the future. There are two main types of proteins in the blood: albumin and globulin. Anemia, pancytopenia, hypercalcemia, and renal disease may be present. 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. 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. Madison (WI):University of Wisconsin Hospitals and Clinics Authority; c2021. Measuring M-Protein SPEP, UPEP Tests | Int'l Myeloma Fdn The most common type of myeloma is IgG kappa, occurring in approximately 52 % of patients. Advertising revenue supports our not-for-profit mission. Some immunoglobulins can be abnormal and may be due to cancer. These tests are performed when the IFE blood test doesn't give . 2009. Globulins comprise a much smaller fraction of the total serum protein content. Given the dismal impact on prognosis in the latter scenario, 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. Several subsets of serum protein electrophoresis are available. Available from: UF Health: University of Florida Health [Internet]. Available from: Maine Health [Internet]. The identification of a monoclonal gammopathy depends on serum and urine protein electrophoresis and immunoelectrophoresis (IFE) 1 and/or quantitative free light chain assays. Hematocrit is a blood test that is used to determine if you have low levels of hemoglobin in your blood (a condition called anemia). Complete Blood Count (CBC). Save my name, email, and website in this browser for the next time I comment. Clin Chem. Arch Pathol Lab Med. Urine immunoelectrophoresis is a lab test that measures immunoglobulins in a urine sample. How is a CSF sample collected for an immunofixation test? Myeloma is a cancer of plasma cells, a type of white blood cell (WBC) in the bone marrow that is responsible for making immunoglobulins. Available from: National Cancer Institute [Internet]. Close more info about Monoclonal Protein on Serum Protein Electrophoresis (M Component), Metabolic Alkalosis: Arterial Blood pH Elevated with Increased Arterial pCO2. This test measures the numbers of red blood cells, white blood cells and platelets in the blood. 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. If all tests are normal, the pattern of follow-up in Figure 36 can be undertaken. Inflammatory Disease/Inflammation; [cited 2019 Dec 18]; [about 3 screens]. Ramakrishnan N, Jialal I. Bence-Jones Protein. 2018 Sep 7. Synonym (s): paraprotein (2) . Anastasios Dimou, MD Resident Physician, Department of Internal Medicine, Albert Einstein Medical CenterDisclosure: Nothing to disclose. https://www.uptodate.com/contents/search. [ 1] Serum or urine immunofixation negative for a monoclonal protein or a polyclonal pattern is. On the contrary, a persistent monoclonal protein despite treatment is a sign of refractory disease. Bone marrow aspirate may be useful to show that at least 10% of the nucleated blood cells are plasma cells. [10]. This website also contains material copyrighted by 3rd parties. All rights reserved. The subgroups are: Measuring the proteins in each subgroup can help diagnose a variety of diseases. Image courtesy of Rush University. 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. Browse the 32 health-related programs and part-time courses available at BCITs School of Health Sciences. If you have questions about your results, talk to your health care provider. Difficulties in immunofixation analysis: a concordance study - Nature No monoclonal band is identified. Please confirm that you would like to log out of Medscape. What specimens can be used to perform an immunofixation test? In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process, and they usually are associated with nonmalignant conditions. 2011. Protein Electrophoresis Serum Test - Healthline [16]. 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. 1976. Morris C, Drake M, Apperley J, et al. Ceruloplasmin, alpha2-macroglobulin, and haptoglobin contribute to the alpha2-protein band. PDF Multiple Myeloma Early Detection, Diagnosis, and Staging Malignant plasma cells in the bone marrow 10% or presence of bony or extramedullary plasmacytoma, confirmed by biopsy. Monoclonal Immunoglobulin (Ig), Monoclonal antibody, Immunofixation Beta1 is composed mostly of transferrin, and beta2 contains beta-lipoprotein. 5 fractions are shown in this image: albumin, alpha-1 ( 1 ), alpha-2 ( 2 ), beta () and gamma (). IgA or some other type). [9]. 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. 11 (2):24. 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. Evidence of monoclonal protein is not apparent." Seiter K, Ponce D. Waldenstrom macroglobulinemia. When a narrow band with sharp borders can be identified, it implies the presence of a monoclonal protein (see image below). 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. If the result is negative, it is safe to conclude that a pure kappa or lambda light chain is present. Immunofixation: Reference Range, Interpretation, Collection and Panels Red top tube for the collection of serum used. 2019 May 23. Urine Test. Monoclonal gammopathy of undetermined significance (MGUS) care at Mayo Clinic. This content does not have an English version. What is the reference range of an immunofixation test? 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. Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel. URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. In healthy individuals, antibodies produced by plasma cells in the bone marrow help this process. Blood appears to be a single substance to the naked eye. This whole (intact) immunoglobulin, made of the four chains, is usually too large to pass through the kidney. Some. Immunofixation can either reveal a normal pattern or identify a monoclonal protein or a polyclonal immunoglobulin pattern. However, the presence of oligoclonal bands does not necessarily confirm the diagnosis, as other conditions can present with oligoclonal bands in the CSF. 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. Monoclonal gammopathy of undetermined significance (MGUS) (adult). 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. Kyle RA, Durie BG, Rajkumar SV, et al. AskMayoExpert. Tax Identification Number: 13-5644916, Myeloma Guide: Information for Patients and Caregivers, A bone marrow aspirationto remove a liquid marrow sample, A bone marrow biopsyto remove a small amount of bone filled with marrow, Malignant plasma cells: Plasma cell level of >10% in a bone marrow biopsy sample, Unusually large amounts of monoclonal protein (called an M spike). 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. Mayo Clinic, Rochester, Minn. April 26, 2019. Follow our channels and share your own adventure. CSF immunofixation that does not reveal oligoclonal bands is also considered normal. [20]. Youve read {{metering-count}} of {{metering-total}} articles this month. 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). If the repeat examination is abnormal or future patterns are abnormal, the next step is to refer the patient to a hematologist-oncologist. The specimen can be serum, urine, or CSF. You don't need any special preparations for an immunofixation blood test. Interpreting serum protein electrophoresis (SPE) patterns The presence of a suspected monoclonal can lead to further testing by immunofixation electrophoresis (IFE). Another test, calledimmunofixation or immunoelectrophoresis, is used to determine the exact type ofabnormal antibody (IgG. Please check with your financial advisor if you have more questions. Learn why immunohistochemistry is the gold standard in testing for certain diseases, including several cancers. Fanning SR, Hussein MA. The search for meaning in monoclonal protein. Is it multiple - PubMed This process is known as electrophoresis. A small number of patients with myeloma have either "oligosecretory disease," in which the detectable level of monoclonal protein is low, or "nonsecretory disease," in which no monoclonal protein can be detected. 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. How is an immunofixation test interpreted? Monoclonal protein | definition of monoclonal protein by Medical dictionary Monoclonal gammopathy of undetermined significance (MGUS) - Mayo Clinic