2017 Dec 28. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. What specimens can be used to perform an immunofixation test? Learn why immunohistochemistry is the gold standard in testing for certain diseases, including several cancers. A doctor may use the results to make a diagnosis or decide on a course of treatment. Blood. Waldenstrom macroglobulinemia always shows a serum IgM-type monoclonal band. Urine protein electrophoresis (UPEP) is, C-reactive protein is produced by the liver in response to inflammation. This abnormal protein is formed within your bone marrow, the soft, blood-producing tissue that fills in the center of most of your bones. 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. MGUS usually causes no problems. We look forward to connecting with you. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. 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). Endoscopy vs. Colonoscopy: How Do They Differ? Bird J, Behrens J, Westin J, et al. Finally, the sample is washed to remove the proteins that do not precipitate and then stained, destained, and dried. ), 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. When these are removed, a liquid is left behind. This content does not have an Arabic version. 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. 2018 Sep 7. [9], In addition, immunofixation can be used to monitor therapy in plasma cell dyscrasias (ie, multiple myeloma and Waldenstrom macroglobulinemia). 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. Characterized by a sharp peak in the beta-gamma region, monoclonal gammopathies involve increased production of immunoglobulins, or antibodies (IgA, IgG, IgM, etc.). My first week back in Chem was spent on the electrophoresis bench. The M protein has an incomplete heavy chain and no light chain. 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. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, for Monoclonal gammopathy of undetermined significance (MGUS), Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Monoclonal gammopathy of undetermined significance (MGUS), Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Essential Thrombocythemia: Looking for information and support. Immunofixation tests can also be done in urine. Sample size: Every drop of urine within 24 hours is included in the sample. SPEP and UPEP don't measure myeloma cells; they measure the output of myeloma cells. [12] an additional assay for the identification of IgD or IgE must be performed. Peripheral blood smear often shows RBCs in a stacked or rouleaux formation. Multiple Myeloma. Platelets Small substances in your blood that help the blood to form a thickened mass (or blood clot) to help stop bleeding. Sasson SC, McGill K, Wienholt L, Carr A, Brown DA, Kelleher AD, et al. Close more info about Monoclonal Protein on Serum Protein Electrophoresis (M Component), Metabolic Alkalosis: Arterial Blood pH Elevated with Increased Arterial pCO2. Here are my blood test results for "Interpretation" part. If you have questions about your results, talk to your health care provider. Monoclonal gammopathy of undetermined significance (MGUS). IgA, IgM, and sometimes IgG, along with complement proteins, also can be identified in the beta fraction. There are five types of heavy chains, and each type is represented by a specific letter: IgG, IgA, IgD, IgE and IgM. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. What is the clinical application of an immunofixation test? 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. Role of urine immunofixation in the complete response assessment of MM patients other than light-chain-only disease. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: leukemia; [cited 2019 Dec 10]; [about 3 screens]. Image courtesy of Rush University. 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. [QxMD MEDLINE Link]. 2016 Jan 27 [cited 2019 Dec 18]; 2016 (1):37-51. In this case, the IgM lane, which is normally absent, is broad with smooth borders. Urine IFE tests are often done if IFE blood test results were not normal. 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. There is less than 10 percent plasma cell involvement on bone marrow biopsy. Blood. Available from: Cancer.Net [Internet]. 147:22-42. Skeletal lesions (e.g., lytic lesions, diffuse osteopenia, vertebral compression fractures) are present in 80 percent of patients. If there's no disease progression, MGUS doesn't require treatment. BCIT students get their phlebotomy competencies signed off during a two-week placement in Level 1, so whether you collect blood during the long block practicum is very much dependent on the practicum site. Malnutrition; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. 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. The information on this site should not be used as a substitute for professional medical care or advice. Less than 10% plasma cells are present in bone marrow, and patients have no lytic bony lesions, anemia, hypercalcemia, or renal insufficiency. 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 Definition. In other cases, patients may have non-specific symptoms, meaning the discovery of a protein band in the serum . Gainesville (FL): University of Florida Health; c2021. Typically, the monoclonal protein is discovered, and workup then ensues. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. The most common condition linked with these abnormal proteins is MGUS. It can also can vary in how that amount relates to the behavior of the myeloma. Next-Generation Sequencing (NGS). There are various types of these proteins that fight different types of infections. Lab Tests Online [Internet]. Share cases and questions with Physicians on Medscape consult. 5 fractions are shown in this image: albumin, alpha-1 (1), alpha-2 (2), beta () and gamma (). Thanks for helping me with this quality post. In Kelowna I had the week of review, and go out 2-3 mornings a week while in Chem and Hematology. 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. A serum free light chain ratio is indicated in the case of a negative immunofixation result when the suspicion for multiple myeloma is still high. If a monoclonal protein is present, a precipitant will form at this phase. Plasma protein levels display reasonably predictable changes in response to acute inflammation, malignancy, trauma, necrosis, infarction, burns, and chemical injury. These tests also can identify the specific protein type involved in your high blood protein levels. 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). How is an immunofixation test interpreted? Other inflammatory conditions of the CNS can present with oligoclonal bands in CSF resulting from intrathecal production of antibodies. If abnormal, the curve may be delineated in the wrong location(s) and should be fixed before the result is filed. The names of these subsets are based on the method that is used to separate and differentiate the various serum components. Immunofixation consists of an electrophoresis phase and a fixation phase. There are a number of reasons why a doctor may order this test. [QxMD MEDLINE Link]. Some people experience mild pain when the needle is inserted. Connect with others like you for support and answers to your questions in the Blood Cancers & Disorders support group on Mayo Clinic Connect, a patient community. There are two types of light chains, referred to as kappa (k) and lambda ().. Electrophoresis is not usually used by itself to diagnose a disease. The alpha1-protein fraction is comprised of alpha1-antitrypsin, thyroid-binding globulin, and transcortin. Levels of albumin are increased in patients with a relative reduction in serum water (e.g., dehydration). Monoclonal gammopathy of undetermined significance. Cytogenetic Analysis. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The serum immunofixation test is most often done with a blood sample. https://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/monoclonal-gammopathy-of-undetermined-significance-mgus?query=mgus. 2021 Feb 1. Some of these patients can befollowed with a newer blood test that measures serum free light chains, which are asmall fragment of the larger intact M protein., An intact immunoglobulin (Ig) molecule is composed of two larger pieces (heavy chains) and two smaller pieces (light chains) that are attached to each other. Anastasios Dimou, MD Resident Physician, Department of Internal Medicine, Albert Einstein Medical CenterDisclosure: Nothing to disclose. This is serum. [14], Mass spectrometry is sometimes employed in place of immunofixation because of the latters limitations, such as in the detection of low-level disease. 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. The immunoelectrophoresis-serum test is used to. Affected patients have hyperviscosity and hypercellular bone marrow with extensive infiltration by lymphoplasma cells. Want to view more content from Cancer Therapy Advisor? 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.