Immunofixation can either reveal a normal pattern or identify a monoclonal protein or a polyclonal immunoglobulin pattern. Blood. Sign-upto receive the latest news on BCIT. 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. Low concentration of monoclonal immunoglobulins (LCMI) Heavy chain disease Suggested Additional Lab Testing For multiple myeloma: In addition to SPEP followed by immunofixation, quantitative. Monoclonal Immunoglobulin (Ig), Monoclonal antibody, Immunofixation Immunofixation tests can also be done in urine. The presence of M proteins can be a sign of a type of cancer called myeloma, or multiple myeloma. Close more info about Monoclonal Protein on Serum Protein Electrophoresis (M Component), Metabolic Alkalosis: Arterial Blood pH Elevated with Increased Arterial pCO2. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. Monoclonal gammopathy of undetermined significance (MGUS) (adult). 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 subgroups are: Measuring the proteins in each subgroup can help diagnose a variety of diseases. 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). The albumin band represents the largest protein component of human serum. This website also contains material copyrighted by 3rd parties. Much of the clinical interest is focused on the gamma region of the serum protein spectrum because immunoglobulins migrate to this region. Monoclonal Protein Study, Serum - mayocliniclabs.com [QxMD MEDLINE Link]. The next most common type is light chain myeloma in which no intact immunoglobulin is produced. This allows them to be measured and analyzed individually. These proteins can also be referred to as an M-spike, monoclonal immunoglobulin, or paraprotein. . 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. Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. AskMayoExpert. 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. Want to view more content from Cancer Therapy Advisor? Exp Ther Med. The peaks for these components lie toward the negative electrode, with the gamma peak being closest to that electrode. Immunofixation detects monoclonal proteins in serum and urine 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. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. These include: You may need testing if you have symptoms of certain diseases, such as multiple myeloma, multiple sclerosis, malnutrition, or malabsorption. Immunofixation to identify the M component as an IgM immunoglobulin with a quantitative IgM level greater than 3 g/dL. 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. Youve read {{metering-count}} of {{metering-total}} articles this month. Medscape Drugs & Diseases. Accessed April 18, 2019. 2019 Jun 20. This usually takes less than five minutes. Serum protein electrophoresis (SPEP) is a laboratory technique thats used to determine the levels of some types of proteins in a blood sample. 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. https://www.uptodate.com/contents/search. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process. We've rounded up the best at-home kidney health test kits. Abnormalities in any of these tests should result in a referral to a hematologist-oncologist. We avoid using tertiary references. Monoclonal gammopathy of undetermined significance (MGUS). Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Madison (WI):University of Wisconsin Hospitals and Clinics Authority; c2021. The precise cause of MGUS isn't known. [18, 19], Detection of a paraprotein by immunofixation is possible in lymphomas. Its not always obvious what high or low protein levels in the blood serum may mean. The identification of a monoclonal gammopathy depends on serum and urine protein electrophoresis and immunoelectrophoresis (IFE) 1 and/or quantitative free light chain assays. Waldenstrom macroglobulinemia always shows a serum IgM-type monoclonal band. Electrophoresis is a method of separating proteins based on their physical properties. Interpreting serum protein electrophoresis (SPE) patterns All rights reserved. Monoclonal protein | definition of monoclonal protein by Medical dictionary A second screen is used to confirm positive test results. An apparent monoclonal protein on serum protein electrophoresis may or may not be a true monoclonal protein. A polyclonal immunoglobulin pattern in the serum or urine immunofixation is considered to be nonspecific. Luzzio C, Dangond F. Multiple sclerosis. Reference Range Immunofixation consists of an electrophoresis phase and a fixation phase. Guido Tricot. Blood Cancer J. Symptoms of malnutrition or malabsorption include: A health care professional will take a blood sample from a vein in your arm, using a small needle. Monoclonal gammopathy of undetermined significance (MGUS). If the curve is relatively normal (e.g. 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. Copyright 2005 by the American Academy of Family Physicians. What is the clinical application of an immunofixation test? Health Encyclopedia - University of Rochester Medical Center Hematology: Basic Principles and Practice. A monoclonal protein is produced by the abnormal, cancerous or precancerous cells. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. A total protein test is often done as part of your regular checkup. Pruthi RK (expert opinion). Instead, they only make light chains. Protein Electrophoresis questions. Save my name, email, and website in this browser for the next time I comment. Keep in mind that these are just clues. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant. IgA or IgM bands are less common. [12] an additional assay for the identification of IgD or IgE must be performed. An accurate diagnosis is one of the most important aspects of a persons medical care. Accessed April 18, 2019. So when the Serum Protein Electrophoresis (SPEP) test shows a spike in M protein, this is a sign of MM. Available from: Systemic Autoinflammatory Disease (SAID) Support [Internet]. These conditions should be promptly diagnosed and treated. The presence of a suspected monoclonal can lead to further testing by immunofixation electrophoresis (IFE). When a narrow band with sharp borders can be identified, it implies the presence of a monoclonal protein (see image below). Albumin, the largest peak, lies closest to the positive electrode. See permissionsforcopyrightquestions and/or permission requests. The search for meaning in monoclonal protein. Is it multiple - PubMed Platelets Small substances in your blood that help the blood to form a thickened mass (or blood clot) to help stop bleeding. When the body produces abnormal antibodies, they are called monoclonal proteins, or M proteins. The various proteins in the body perform different functions. Please confirm that you would like to log out of Medscape. 2019 May 23. The disorder occurs most commonly in older men. 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. Your story might just end up on BCIT News. Myeloma affects white blood cells called plasma cells in the bone marrow. [Full Text]. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Lab Tests Online [Internet]. Complete Blood Count (CBC). Ferri FF. 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. Medscape Drugs & Diseases. Lahuerta JJ, Jimenez-Ubieto A, Paiva B, et al. 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. University of Rochester Medical Center [Internet]. PDF Understanding Your Lab Results - Myeloma Central The stained gel is then sent to a pathologist for diagnosis. The protein electrophoresis test is often used to find abnormal substances called M proteins. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Multiple Myeloma | Diagnosis of Multiple Myeloma | LLS 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. The monoclonal band is seen in: Multiple myelomas show in 99 % of the patients in serum and urine. Autoinflammatory vs. Autoimmune: What is the Difference? 2nd Ed, Kindle. 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. Medscape Drugs & Diseases. 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. People with monoclonal gammopathy generally don't experience signs or symptoms. Fanning SR, Hussein MA. what does no apparent monoclonal protein on serum electrophoresis mean However, the presence of oligoclonal bands does not necessarily confirm the diagnosis, as other conditions can present with oligoclonal bands in the CSF. 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. High blood protein When to see a doctor - Mayo Clinic 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. Serum protein electrophoresis is an inexpensive, easy-to-perform screening procedure for initial identification of monoclonal bands. 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. 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. All Rights Reserved. The pattern of serum protein electrophoresis results depends on the fractions of two major types of protein: albumin and globulins. 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. In: Goldman-Cecil Medicine. Measuring M-Protein SPEP, UPEP Tests | Int'l Myeloma Fdn 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. 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. Instead, its used along with other laboratory tests to provide more information to help with diagnosis. 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. If you have questions about your results, talk to your health care provider. 2011. Available from: UW Health [Internet]. On the contrary, a persistent monoclonal protein despite treatment is a sign of refractory disease. Synonym (s): paraprotein (2) . Most patients with untreated myeloma have a monoclonal immunoglobulin spike in serum, urine, or both. https://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/monoclonal-gammopathy-of-undetermined-significance-mgus?query=mgus. 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. 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. Electrophoresis is not usually used by itself to diagnose a disease. Immunofixation in CSF for the detection of oligoclonal bands is indicated every time there is suspicion for multiple sclerosis. The test separates these proteins into subgroups based on their size and electrical charge. Immunoglobulins are secreted by plasma cells, a type of white blood cell in the bone marrow, in response to infection and disease. All rights reserved. Washington D.C.: American Association for Clinical Chemistry; c20012019. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: lymphoma; [cited 2019 Dec 10]; [about 3 screens]. 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). Proteins play many important roles, including providing energy for the body, rebuilding muscles, and supporting the immune system. Myeloma Protein (M Protein): What Is It? | MyMyelomaTeam How is a urine sample collected for an immunofixation test? Diagnosis requires 10 to 15 percent plasma cell involvement on bone marrow biopsy. There is less than 10 percent plasma cell involvement on bone marrow biopsy. Immunofixation electrophoretic techniques applied to identification of proteins in serum and cerebrospinal fluid. Clin Chem. The gamma-globulin zone is decreased in hypogammaglobulinemia and agammaglobulinemia. No abstract available. The band pattern is specific for certain diseases. Keywords: bone marrow; monoclonal protein; multiple myeloma; protein electrophoresis; serum free light chains. [20]. The output of monoclonal protein can vary from patient to patient. PDF Understanding Your Lab Results - Myeloma Central Copyright 2017, 2013 Decision Support in Medicine, LLC. This is a normal serum protein electrophoresis (SPE) pattern; also listed are a few of the proteins associated with each fraction. Plasma cell disorders. These tests also can identify the specific protein type involved in your high blood protein levels. If Waldenstrms macroglobulinemia or other lymphoproliferative process is suspected, an abdominal computed tomographic scan and bone marrow aspiration and biopsy should be performed. 5 fractions are shown in this image: albumin, alpha-1 (1), alpha-2 (2), beta () and gamma (). However, you shouldnt have a lot of protein in your urine. 133 (25):2664-8. 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. 147:22-42. There are two main types of proteins in the blood: albumin and globulin. The Leukemia & Lymphoma Society (LLS) is a global leader in the fight against blood cancer. 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. In this case, the IgM lane, which is normally absent, is broad with smooth borders. Available from: National Cancer Institute [Internet]. Available from: https://ufhealth.org/protein-electrophoresis-serum. Bone marrow aspirate may be useful to show that at least 10% of the nucleated blood cells are plasma cells. Gainesville (FL): University of Florida Health; c2021. These measurements indicate the degree to which the myeloma cells in the marrow are affecting normal blood cell development. A serum thyroxine-binding globulin (TBG) level test is a blood test that measures the amount of TBG in your blood. Evidence of monoclonal protein is not apparent." 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. Unattached, free light chains enter the blood and are excreted rapidly in the urine. Follow our channels and share your own adventure. A colonoscopy is specifically used to look at the colon. 2023 Healthline Media LLC. Kyle RA, Durie BG, Rajkumar SV, et al. Given the dismal impact on prognosis in the latter scenario, Inflammatory Disease/Inflammation; [cited 2019 Dec 18]; [about 3 screens]. No Monoclonal Protein in a Patient with CRAB Features Peripheral blood contains more than 20 percent plasma cells. Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, Association for Molecular Pathology, College of American PathologistsDisclosure: Nothing to disclose. The information on this site should not be used as a substitute for professional medical care or advice. Chromosomal abnormalities play a crucial role in identifying cancerous cells and determining the risk of relapse. Serum Protein Electrophoresis (SPEP) Test; [cited 2021 Aug 9]; [about 3 screens]. In blood cancers such as myeloma, the 'M' in 'M protein' stands for monoclonal. See additional information. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. It involves exposing serum placed in a special type of gel to an electric current. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: leukemia; [cited 2019 Dec 10]; [about 3 screens]. Approximately 40 percent of myeloma cases are characterized by the presence of trisomies (three copies of a chromosome) in the malignant plasma cells, while in most of the rest there is a translocation involving chromosome 14 (the site of a gene for the immunoglobulin heavy chain). Urbancek S, Gascon P, Schwartz RA, Jacobson DR, Buxbaum JN, Bogdan CA. 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. 2009. This whole (intact) immunoglobulin, made of the four chains, is usually too large to pass through the kidney. Cancer.Net [Internet]. Ceruloplasmin, alpha2-macroglobulin, and haptoglobin contribute to the alpha2-protein band.
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