Morris C, Drake M, Apperley J, et al. The band pattern is specific for certain diseases. A homogeneous spike-like peak in a focal region of the gamma-globulin zone indicates a monoclonal gammopathy. 2018 Dec 3. 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 Interpreting serum protein electrophoresis (SPE) patterns [Full Text]. Again, the lanes are broad and the transition to the lane borders is smooth. Beaumont-Epinette MP, Moreau C, Besnard S, Latute F, Collet N, Sebillot M, et al. Medscape Drugs & Diseases. Available from: Lab Tests Online [Internet]. Health Encyclopedia: Immunofixation (Blood); [cited 2019 Dec 10]; [about 2 screens]. Monoclonal bands are usually seen in the zone but may be seen in proximity of the band or, rarely, in the 2 region. Affected patients have only one tumor, with no other bone lesions and no urine or serum abnormalities. Rajhumar SV. Abnormalities in any of these tests should result in a referral to a hematologist-oncologist. 2017 Dec 28. 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. Sample: Serum (whole blood or plasma is inappropriate, as fibrinogen may alter the results), Sample: 24-hour urine collection, concentrated. Multiple Myeloma. For patients with MGUS and high risk for progression to multiple myeloma, surveillance should be performed at 6 months and then yearly thereafter. 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. Sasson SC, McGill K, Wienholt L, Carr A, Brown DA, Kelleher AD, et al. We've rounded up the best at-home kidney health test kits. Evol Med Public Health. Anemia, pancytopenia, hypercalcemia, and renal disease may be present. In Kelowna I had the week of review, and go out 2-3 mornings a week while in Chem and Hematology. The various proteins in the body perform different functions. These conditions should be promptly diagnosed and treated. [9], In addition, immunofixation can be used to monitor therapy in plasma cell dyscrasias (ie, multiple myeloma and Waldenstrom macroglobulinemia). Medscape Drugs & Diseases. What Is M Protein? You are being redirected to University of Rochester Medical Center [Internet]. Collection in a container: A plastic collection container is used. On the contrary, a persistent monoclonal protein despite treatment is a sign of refractory disease. Immune Thrombocytopenia Purpura (ITP): What helps? However, blood has several components. When there is damage to the kidneys, other proteins, such as albumin, may also be present in the urine. Multiple Myeloma: Diagnosis; 2018 Jul [cited 2019 Dec 10]; [about 3 screens]. 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. Youve read {{metering-count}} of {{metering-total}} articles this month. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. Clin Chem. This causes the different types of proteins to move and group together. Available from: National Multiple Sclerosis Society [Internet]. 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 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. 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). Some immunoglobulins can be abnormal and may be due to cancer. Blood Cancer J. 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. Instead, its used along with other laboratory tests to provide more information to help with diagnosis. Monoclonal gammopathy of undetermined significance (MGUS) (adult). Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: multiple myeloma; [cited 2019 Dec 10]; [about 3 screens]. A hair strand drug test can be used to detect drugs used over the past 90 days. Some people experience mild pain when the needle is inserted. If the result is negative, it is safe to conclude that a pure kappa or lambda light chain is present. This is a normal serum protein electrophoresis (SPE) pattern; also listed are a few of the proteins associated with each fraction. These values may vary slightly from facility to facility. There are two main types of proteins in the blood: albumin and globulin. There are a number of reasons why a doctor may order this test. Immunoglobulin-related amyloidosis. Inflammatory diseases include. Characterized by a sharp peak in the beta-gamma region, monoclonal gammopathies involve increased production of immunoglobulins, or antibodies (IgA, IgG, IgM, etc.). Monoclonal gammopathies are conditions in which abnormal proteins are found in the blood. [10]. [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. These tests are performed when the IFE blood test doesn't give . These include an elevated protein level, anemia and abnormalities in kidney function or calcium levels. 5 fractions are shown in this image: albumin, alpha-1 (1), alpha-2 (2), beta () and gamma (). 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. Pruthi RK (expert opinion). Portland (ME): Maine Health; c2019. When you arrive, a healthcare professional will simply use a needle to take a blood sample. A concomitant measurement of the creatinine in the 24-hour urine sample for correction of sampling errors has been proposed. If the serum M-protein spike is 1.5 to 2.5 g per dL, it is important to perform nephelometry to quantify the immunoglobulins present and to obtain a 24-hour urine collection for electrophoresis and immunofixation. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Electrophoresis is a lab technique used to separate groups of proteins in blood serum. 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. The Licensed Content is the property of and copyrighted by DSM. Immunofixation "fixes" certain proteins into place with antibodies and then washes away the others before staining them. [QxMD MEDLINE Link]. A total protein test can determine whether you have high blood protein. 117:4701-5. Many subspecialists. Moving toward the negative portion of the gel (i.e., the negative electrode), the next peaks involve the alpha1 and alpha2 components. [Full Text]. Peripheral blood contains more than 20 percent plasma cells. Highly trained oncology social workersand nurses. The remainder had hypogammaglobulinemia or a normal-appearing pattern. Abnormal levels of certain chemicals may indicate that an organ is not working properly or they may be caused by cancer or other health conditions. The specimen can be serum, urine, or CSF. They have a number of roles: Too much or too little protein can cause problems. Available from: National Cancer Institute [Internet]. URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. Complete Blood Count (CBC). The lab will also treat the gel so that it only keeps . Save my name, email, and website in this browser for the next time I comment. [Full Text]. If abnormal, the curve may be delineated in the wrong location(s) and should be fixed before the result is filed. In many myeloma patients, the coordinated process of making and attaching light chains and heavy chains fails in the malignant plasma cells. Serum is placed on a specific medium, and a charge is applied. Alpha-1 Antitrypsin; [updated 2019 Nov 13; cited 2019 Dec 10]; [about 2 screens]. This is serum. Evidence of monoclonal protein is not apparent." Mayo Clinic, Rochester, Minn. April 26, 2019. (2015, August 21). Diagnosis is often done with a lab test called electrophoresis. Continuing Medical Education (CME/CE) Courses. Difficulties in immunofixation analysis: a concordance study - Nature PDF Multiple Myeloma Early Detection, Diagnosis, and Staging A second screen is used to confirm positive test results. This content does not have an English version. A doctor may use the results to make a diagnosis or decide on a course of treatment. Pathology. Proteins are substances made of small chemicals called amino acids. Testing a 24-hour urine sample allows for an accurate measurement of the level of kidney function and can indicate possible kidney damage from myeloma. Subsequent immunofixation with electrophoresis identified the monoclonal protein as an IgG antibody (paraprotein) with a lambda light chain (arrow). SPEP is used to help diagnose and monitor a variety of different diseases or disorders that have abnormal proteins or protein levels. All rights reserved. Making sense of serum protein bands - Best Tests July 2011 - bpac 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. 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. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Is there something going on we should know about? Learn why immunohistochemistry is the gold standard in testing for certain diseases, including several cancers. My first week back in Chem was spent on the electrophoresis bench. On a computer screen, these proteins form a pattern of bands. 5th. These tests also can identify the specific protein type involved in your high blood protein levels. Affected patients have no lytic bone lesions, no anemia, no hypercalcemia, and no renal 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. The light chain is also called the Bence Jones protein, named for the doctor Henry Bence Jones who studied its characteristics. People with monoclonal gammopathy generally don't experience signs or symptoms. IgA or IgM bands are less common. Mass spectrometry for the evaluation of monoclonal proteins in multiple myeloma and related disorders: an International Myeloma Working Group Mass Spectrometry Committee Report. Pathol Biol (Paris). Rochester (NY): University of Rochester Medical Center; c2019. 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. Alexandria (VA): American Society of Clinical Oncology; 20052019. Mayo Clinic does not endorse companies or products. CancerTherapyAdvisor.com is a free online resource that offers oncology healthcare professionals a comprehensive knowledge base of practical oncology information and clinical tools to assist in making the right decisions for their patients. 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. 2015 Oct. 47 (6):564-9. 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. 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.