what does no apparent monoclonal protein on serum electrophoresis mean

Copyright 2017, 2013 Decision Support in Medicine, LLC. Myelomacells produce many copies of its anibody. [Full Text]. 2016 Jan 27 [cited 2019 Dec 18]; 2016 (1):37-51. It can also can vary in how that amount relates to the behavior of the myeloma. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. When the whole immunoglobulin is present in the urine, it is usually at a low level. During the fixation phase, antiserum containing anti-IgG, anti-IgA, anti-IgM, anti-light chain kappa, or anti-light chain lambda is inoculated with the serum proteins. [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. Diagnosis is often done with a lab test called electrophoresis. Clinical course and management of monoclonal gammopathy of undetermined significance. 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. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests; [cited 2020 Jan 5]; [about 3 screens]. Instead, they only make light chains. Exp Ther Med. The presence of M proteins can be a sign of a type of cancer called myeloma, or multiple myeloma. The test may also be performed again in the future. 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). [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 presence of a suspected monoclonal can lead to further testing by immunofixation electrophoresis (IFE). Since the expression levels of these genes and how mutations in them, if present, influence the behavior of the myeloma cells, these techniques may be helpful in better predicting treatment outcomes and developing new and improved targeted therapies. 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. 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. SPEP and UPEP don't measure myeloma cells; they measure the output of myeloma cells. 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. The next five components (globulins) are labeled alpha1, alpha2, beta1, beta2, and gamma. This is serum. How is a CSF sample collected for an immunofixation test? Cawley LP, Minard BJ, Tourtellotte WW, et al. An apparent monoclonal protein on serum protein electrophoresis may or may not be a true monoclonal protein. 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). Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel. excess of an abnormal immunoglobulin called monoclonal protein (or M protein). M protein is made by abnormal plasma cells. Immunofixation in CSF for the detection of oligoclonal bands is indicated every time there is suspicion for multiple sclerosis. Hematology: Basic Principles and Practice. [10]. 2019 Jan. [QxMD MEDLINE Link]. Further investigation will usually be needed to make a definitive diagnosis. Goldman L, et al., eds. Some. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. This pattern represents the presence of polyclonal immunoglobulin. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. M-protein is an antibodyor part of an antibodythat can show up in tests of your blood and/or urine, and its presence can mean different things. Malnutrition, significant liver disease, renal loss (e.g., in nephrotic syndrome), hormone therapy, and pregnancy may account for a low albumin level. 1 The term monoclonal gammopathy of undetermined significance (MGUS) was coined by Dr. Robert Kyle in 1978 to describe an asymptomatic plasma cell dyscrasia characterized by a . This can help the doctor decide how well therapies and medicines are working. The output of monoclonal protein can vary from patient to patient. Accessed April 18, 2019. See additional information. Accessed April 18, 2019. Albumin, the major protein component of serum, is produced by the liver under normal physiologic conditions. ), 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 should be noted that immunoglobulins often can be found throughout the electrophoretic spectrum. 2019 Jun 20. Subsequent immunofixation with electrophoresis identified the monoclonal protein as an IgG antibody (paraprotein) with a lambda light chain (arrow). Serum protein electrophoresis is an inexpensive, easy-to-perform screening procedure for initial identification of monoclonal bands. 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. Mayo Clinic, Rochester, Minn. April 26, 2019. Pathology. Leukemia. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Given the dismal impact on prognosis in the latter scenario, Immunofixation "fixes" certain proteins into place with antibodies and then washes away the others before staining them. All rights reserved. A total protein test is often done as part of your regular checkup. correct number of peaks and protein values), the analyzer does a pretty good job of identifying each fraction. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. There are two main types of proteins in the blood: albumin and globulin. 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. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. ; 2014 Mar 14 [cited 2020 Jan 22]; [about 3 screens]. The stained gel is then sent to a pathologist for diagnosis. Head over to share your story and tell us about it. What specimens can be used to perform an immunofixation test? [Full Text]. The article also provides a simple guide to result interpretation and suggestions on follow-up of abnormal results. A decreased alpha1-protein band may occur because of alpha1-antitrypsin deficiency or decreased production of the globulin as a result of liver disease. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Some people may experience a rash or nerve problems, such as numbness or tingling. Am J Clin Pathol. This is a normal serum protein electrophoresis (SPE) pattern; also listed are a few of the proteins associated with each fraction. [Full Text]. 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. [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. 5th. IgA or IgM bands are less common. M protein is an abnormal protein caused by plasma cells. An immunofixation blood test, also known as protein electrophoresis, measures certain proteins in the blood. This test is called serum protein electrophoresis (SPEP) test. However, you shouldnt have a lot of protein in your urine. Shah D, Seiter K. Multiple myeloma. 11 (2):24. Sometimes, however, the results of this examination can be confusing or difficult to interpret. MGUS is usually detected by chance when you have a blood test for another condition. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. This process is known as electrophoresis. The method can be used to examine specific proteins in the blood, urine, and other body fluids. We avoid using tertiary references. No monoclonal band is identified. The IFX test can also be used to study changes in the structure of normal. Monoclonal gammopathies of undetermined significance. Monoclonal gammopathy of undetermined significance (MGUS) care at Mayo Clinic. 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. Healthcare providers treat the underlying cause of the immune response to help treat polyclonal gammopathy. Your doctor may also order more tests. A colonoscopy is specifically used to look at the colon. Malignant plasma cells in the bone marrow 10% or presence of bony or extramedullary plasmacytoma, confirmed by biopsy. SPEP is used to help diagnose and monitor a variety of different diseases or disorders that have abnormal proteins or protein levels. These tests are done in conjunction with immunofixation for example, serum immunofixation electrophoresis (SIFE), which identifies immunoglobulins in blood samples. 9 (5):1895-1900. Malnutrition; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. 25th ed. 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). URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. Ronald Hoffman, Leslie E. Silberstein, Sanford J. Shattil, Bruce Furie, Philip McGlave. In some patients, the myeloma cells do not make a complete monoclonal immunoglobulin molecule with two heavy and two light chains. Blood. Kaplan JS, Horowitz GL. Multiple Myeloma: Symptoms and Signs; 2016 Oct [cited 2019 Dec 10]; [about 3 screens]. Urine immunofixation uses electricity to push proteins from your urine sample through a kind of gel. Medscape Drugs & Diseases. 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. If serum protein electrophoresis is abnormal at any time during the follow-up, a referral should be made. If a monoclonal protein is present, a precipitant will form at this phase. 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. Visual examination of electrophoretic patterns by a pathologist is the most sensitive method of detecting monoclonal proteins since small bands may be obscured in densitometric scans. Accessed April 18, 2019. [Full Text]. 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).

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