what does no apparent monoclonal protein on serum electrophoresis mean

If present, an excessive production of a monoclonal immunoglobulin may be shown in laboratory test results as a spike on a graph (M spike). [Full Text]. Malnutrition; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. The most common type of myeloma is IgG kappa, occurring in approximately 52 % of patients. Urine immunoelectrophoresis is a lab test that measures immunoglobulins in a urine sample. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests; [cited 2020 Jan 5]; [about 3 screens]. Rochester (NY): University of Rochester Medical Center; c2019. Murray DL, Puig N, Kristinsson S, et al. Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. 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. 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). So when the Serum Protein Electrophoresis (SPEP) test shows a spike in M protein, this is a sign of MM. Philadelphia, PA, USA: Elsevier Churchill Livingstone; 2008. chapter 87. Because MGUS is not harmful, it doesn't need to be treated. M-protein level is usually greater than 3 g per dL. 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. In addition, a beta2 microglobulin test, a CRP test, and a 24-hour urine collection for electrophoresis and immunofixation should be performed. When is an immunofixation test indicated? Merck Manual Professional Version. Monoclonal gammopathy of undetermined significance (MGUS). Alexandria (VA): American Society of Clinical Oncology; 20052019. The next most common type is light chain myeloma in which no intact immunoglobulin is produced. Fanning SR, Hussein MA. 11 (2):24. Portland (ME): Maine Health; c2019. [QxMD MEDLINE Link]. Typically present in low amounts, conditions such as multiple myeloma and Waldenstrms macroglobulinemia show proliferation of abnormal or cancerous plasma cells. What Is M Protein? 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. Kyle RA, Durie BG, Rajkumar SV, et al. High protein levels may be caused by many conditions. Multiple Myeloma: Diagnosis; 2018 Jul [cited 2019 Dec 10]; [about 3 screens]. 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. Patients with monoclonal gammopathy of undetermined significance require close follow-up because about 1 percent per year develop multiple myeloma or another malignant monoclonal gammopathy.13 [Evidence level B, prospective cohort study] An algorithm for the follow-up of patients with a monoclonal gammopathy is provided in Figure 3.6. The band pattern is specific for certain diseases. The method can be used to examine specific proteins in the blood, urine, and other body fluids. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. [15], However,a study by Lahuerta et al indicated that, with the exception of persons with light-chainonly disease, urine immunofixation is not needed in combination with serum immunofixation to define complete response in multiple myeloma. The LLS mission: Cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. Available from: Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. That criteria is determined by a pathologist who reviews the bone marrow aspirate slides. 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. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 147:22-42. Leukemia. These tests are done in conjunction with immunofixation for example, serum immunofixation electrophoresis (SIFE), which identifies immunoglobulins in blood samples. Given the dismal impact on prognosis in the latter scenario, If the monoclonal protein level decreases or is undetectable after chemotherapy, it might indicate a response to treatment. Malignant plasma cells in the bone marrow 10% or presence of bony or extramedullary plasmacytoma, confirmed by biopsy. Monoclonal gammopathy of undetermined significance. The information on this site should not be used as a substitute for professional medical care or advice. 135:1048-51. 9 (5):1895-1900. Affected patients have few bone lesions and few hematologic disturbances. As denoted in the normal curve above, antibodies are primarily found in the fraction. Available from: Maine Health [Internet]. Thanks for helping me with this quality post. Evol Med Public Health. Protein Electrophoresis questions. There are a number of reasons why a doctor may order this test. This allows them to be measured and analyzed individually. [Full Text]. Your doctor may recommend SPEP if you are experiencing symptoms of a condition affecting the proteins in your blood serum. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Br J Haematol. Cavuoti D, Baskin L, Jialal I. If Waldenstrms macroglobulinemia or other lymphoproliferative process is suspected, an abdominal computed tomographic scan and bone marrow aspiration and biopsy should be performed. 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. Subsequent immunofixation with electrophoresis identified the monoclonal protein as an IgG antibody (paraprotein) with a lambda light chain (arrow). 2015 Aug 26. 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. Imaging Tests. MGUS is usually detected by chance when you have a blood test for another condition. These tests also can identify the specific protein type involved in your high blood protein levels. bone pain. Available from: National Cancer Institute [Internet]. 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). There are various types of these proteins that fight different types of infections. It should be noted that immunoglobulins often can be found throughout the electrophoretic spectrum. This website also contains material copyrighted by 3rd parties. A hair strand drug test can be used to detect drugs used over the past 90 days. A colonoscopy is specifically used to look at the colon. No monoclonal band is identified. Immunoglobulins are proteins that function as antibodies, which fight infection. An accurate diagnosis is one of the most important aspects of a persons medical care. 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. Cancer.Net [Internet]. What specimens can be used to perform an immunofixation test? Blood appears to be a single substance to the naked eye. See additional information. Affected patients have no M protein in their urine, no lytic bone lesions, no anemia, no hypercalcemia, and no renal disease. [QxMD MEDLINE Link]. This monoclonal gammopathy occurs in younger patients. Copyright 2023 Haymarket Media, Inc. All Rights Reserved Red top tube for the collection of serum used. Immunofixation to identify the M component as an IgM immunoglobulin with a quantitative IgM level greater than 3 g/dL. Monoclonal antibodies could be used as myeloma treatments and can be identified by serum protein electrophoresis and immunofixation electrophoresis. Bone marrow biopsy may be useful to show aggregates of plasma cells in focal or diffuse patterns. Low concentration of monoclonal immunoglobulins (LCMI) Heavy chain disease Suggested Additional Lab Testing For multiple myeloma: In addition to SPEP followed by immunofixation, quantitative. Mayo Clinic does not endorse companies or products. Hematology: Basic Principles and Practice. Copyright 2023 American Academy of Family Physicians. 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. These measurements indicate the degree to which the myeloma cells in the marrow are affecting normal blood cell development. [10], Primary screening for plasma cell dyscrasias, No studies have addressed the role of serum or urine immunofixation in screening of the general population for multiple myeloma and related disorders. The region is sometimes divided into 1 and 2, which would account for a sixth fraction. Definitive diagnosis of multiple myeloma requires 10 to 15 percent plasma cell involvement as determined by bone marrow biopsy. If you have questions about your results, talk to your health care provider. Our website services, content, and products are for informational purposes only. Following my rotation in Anatomical Pathology, I spent one week on accessioning review and another three in Chemistry. 109:585-8. (2015, August 12), Serum protein electrophoresis. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. (2015, August 21). 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. 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. Am J Clin Pathol. 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. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: multiple myeloma; [cited 2019 Dec 10]; [about 3 screens]. Some. Sometimes, however, the results of this examination can be confusing or difficult to interpret. 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. The monoclonal band is seen in: Multiple myelomas show in 99 % of the patients in serum and urine. 2019 Jan. [QxMD MEDLINE Link]. 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. IFE classifies the monoclonal based on the type of heavy (IgG, IgA or IgM) and light (kappa or lambda) chains that make up the antibodies. Characterized by a sharp peak in the beta-gamma region, monoclonal gammopathies involve increased production of immunoglobulins, or antibodies (IgA, IgG, IgM, etc.). Washington D.C.: American Association for Clinical Chemistry; c20012019. However, the presence of oligoclonal bands does not necessarily confirm the diagnosis, as other conditions can present with oligoclonal bands in the CSF. Profile Information: Reflex Test: MGUS causes no symptoms. [14], Mass spectrometry is sometimes employed in place of immunofixation because of the latters limitations, such as in the detection of low-level disease. [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. 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. Reference Range Immunofixation consists of an electrophoresis phase and a fixation phase. 2nd Ed, Kindle. Then it says: "The SPE pattern appears essentially unremarkable. It involves exposing serum placed in a special type of gel to an electric current. Image courtesy of Rush University. Electrophoresis is not usually used by itself to diagnose a disease. Close more info about Monoclonal Protein on Serum Protein Electrophoresis (M Component), Metabolic Alkalosis: Arterial Blood pH Elevated with Increased Arterial pCO2. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjA4Njk3Ni1vdmVydmlldw==. These include an elevated protein level, anemia and abnormalities in kidney function or calcium levels. 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. 117:4701-5. 25th ed. This usually takes less than five minutes. The gamma-globulin zone is decreased in hypogammaglobulinemia and agammaglobulinemia. 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. Common causes of high levels include: Low protein levels may be caused by many conditions. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. Immunofixation electrophoretic techniques applied to identification of proteins in serum and cerebrospinal fluid. Medscape Drugs & Diseases. Clin Chem. 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). You can learn more about how we ensure our content is accurate and current by reading our. 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. The most common condition linked with these abnormal proteins is MGUS. The stained gel is then sent to a pathologist for diagnosis. 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. There are two main types of proteins in the blood: albumin and globulin. Are you a BCIT News insider? Goldman L, et al., eds. Medscape Drugs & Diseases. The following table shows what most labs would consider normal results for SPEP testing. Washington D.C.: American Association for Clinical Chemistry; c20012019. [Full Text]. 2023 Healthline Media LLC. Ramakrishnan N, Jialal I. Bence-Jones Protein. Medscape Drugs & Diseases. Levels of albumin are increased in patients with a relative reduction in serum water (e.g., dehydration). A total protein test can determine whether you have high blood protein. This test is called serum protein electrophoresis (SPEP) test. Serum protein electrophoresis (SPEP) is a laboratory technique thats used to determine the levels of some types of proteins in a blood sample. 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 Diagnosis of monoclonal gammopathy of undetermined significance. Urine IFE tests are often done if IFE blood test results were not normal. The next five components (globulins) are labeled alpha1, alpha2, beta1, beta2, and gamma. 2019 Jul 15. 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. Gainesville (FL): University of Florida Health; c2021. Suspected multiple myeloma, Waldenstrms macroglobulinemia, primary amyloidosis, or related disorder, Unexplained peripheral neuropathy (not attributed to longstanding diabetes mellitus, toxin exposure, chemotherapy, etc. 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. 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. Role of urine immunofixation in the complete response assessment of MM patients other than light-chain-only disease. A decreased alpha1-protein band may occur because of alpha1-antitrypsin deficiency or decreased production of the globulin as a result of liver disease. [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. 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. Fortunately, the cause of an abnormal curve is not always pathologic. 2011. ), 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. It can also detect changes in the ratio of kappa and lambda light chain production, which indicates an excess of abnormal plasma cells. 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. [10, 17], A 24-hour concentrated urine sample is appropriate for urine immunofixation. Keywords: bone marrow; monoclonal protein; multiple myeloma; protein electrophoresis; serum free light chains. 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. Peripheral blood contains more than 20 percent plasma cells. An endoscopy is used in a wide range of testing throughout the body. Save my name, email, and website in this browser for the next time I comment. All Rights Reserved. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant. Cytogenetic Analysis. 2010. Last medically reviewed on October 20, 2016, Proteins are found in the blood of healthy people. Browse the 32 health-related programs and part-time courses available at BCITs School of Health Sciences. A C-reactive protein test, or CRP test, measures the amount of CRP in your. Genetic changes and environmental triggers appear to play a role. If a monoclonal protein is present, a precipitant will form at this phase. The immunoelectrophoresis-serum test is used to. The SFLC assay can detect abnormal levels of free light chains, which may be an indication of a plasma cell disorder. In healthy individuals, antibodies produced by plasma cells in the bone marrow help this process. Immunoglobulin-related amyloidosis. Accessed April 18, 2019. [ 1] Serum or urine immunofixation negative for a monoclonal protein or a polyclonal pattern is. National Multiple Sclerosis Society; MS Symptoms; [cited 2019 Dec 18]; [about 3 screens]. Want to view more content from Cancer Therapy Advisor? 2011. The following imaging tests are a very important part of the diagnosis, staging and management of myeloma: If you're diagnosed with myeloma, you may need to undergo more tests during or after treatment to see how themyeloma cells are responding to therapy. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Complete Blood Count (CBC). NGS can identify mutations present in the genes of the myeloma cells. Bone marrow aspirate may be useful to show that at least 10% of the nucleated blood cells are plasma cells. We use cookies to enhance your experience. There is very little risk to having a blood test. 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.

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what does no apparent monoclonal protein on serum electrophoresis mean

what does no apparent monoclonal protein on serum electrophoresis mean