Protein Electrophoresis Serum Test - Healthline Monoclonal Proteins (M Proteins) | Myeloma Center 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. Diagnosis requires 10 to 15 percent plasma cell involvement on bone marrow biopsy. Levels of albumin are increased in patients with a relative reduction in serum water (e.g., dehydration). The speed of movement is dictated by their charge. Proteins play many important roles, including providing energy for the body, rebuilding muscles, and supporting the immune system. You can also contact us directly if you need to. (2015, August 21). Murray DL, Puig N, Kristinsson S, et al. Available from: Lab Tests Online [Internet]. 2017 Dec 28. 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. In addition, a beta2 microglobulin test, a CRP test, and a 24-hour urine collection for electrophoresis and immunofixation should be performed. Image courtesy of Rush University. 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. 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. Twenty-four-hour Bence-Jones protein determinations: can we ensure accuracy?. 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. Quantitation of Serum Monoclonal Proteins - Oxford Academic If the repeat examination is abnormal or future patterns are abnormal, the next step is to refer the patient to a hematologist-oncologist. 2019 Jun 20. Madison (WI):University of Wisconsin Hospitals and Clinics Authority; c2021. Lab Tests Online [Internet]. The released hemoglobin can also bind to haptoglobin, a protein in the 2 fraction, forming a hemoglobin-haptoglobin complex that blurs the 2 and separation and may resemble a malignant peak. In the interpretation of serum protein electrophoresis, most attention focuses on the gamma region, which is composed predominantly of antibodies of the IgG type. Flow Cytometry. If all tests are normal, the pattern of follow-up in Figure 36 can be undertaken. Given the dismal impact on prognosis in the latter scenario, The various proteins in the body perform different functions. Retrieved from, Understanding serum protein electrophoresis, What abnormal results for SPEP test may mean, How test results may be used to decide future care, urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=protein_electrophoresis_serum, labtestsonline.org/understanding/analytes/electrophoresis, Serum Thyroxine-Binding Globulin (TBG) Level Test, Everything You Should Know About a Hair Strand Drug Test, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI. In Kelowna I had the week of review, and go out 2-3 mornings a week while in Chem and Hematology. Protein electrophoresis alone is not considered an adequate screen for monoclonal gammopathies. Available from: Lab Tests Online [Internet]. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Monoclonal gammopathy is present in up to 8 percent of healthy geriatric patients.12 All patients with monoclonal gammopathy require further evaluation to determine the cause of the abnormality. All rights reserved. excess of an abnormal immunoglobulin called monoclonal protein (or M protein). Does My Patient with a Serum Monoclonal Spike have Multiple Myeloma? This process is known as electrophoresis. Your doctor may recommend SPEP if you are experiencing symptoms of a condition affecting the proteins in your blood serum. Plasma cell disorders. In some cases, the test is done with a urine sample. Available from: National Cancer Institute [Internet]. Bone Marrow Tests. It involves exposing serum placed in a special type of gel to an electric current. 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. IgA or IgM bands are less common. 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. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. The proteins create separate bands on the gel, which are then analyzed by the laboratory. 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. See permissionsforcopyrightquestions and/or permission requests. Reference Range Immunofixation consists of an electrophoresis phase and a fixation phase. Its a useful skill to maintain, as technologists especially those on off-shifts or at smaller sites may still collect through their career(s). Accessed April 18, 2019. Copyright 2023 American Academy of Family Physicians. Serum protein electrophoresis is a laboratory examination that commonly is used to identify patients with multiple myeloma and other disorders of serum protein. [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. This test is most often used to help diagnose or monitor a variety of different conditions. [QxMD MEDLINE Link]. The band pattern is specific for certain diseases. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis. Serum free light chain testing provides complementary information to the two protein electrophoresis tests: SPEP and UPEP. Urine Test. Monoclonal light chains also called or Bence Jones protein, are seen in the urine of Multiple myeloma cases in 75 % of the patients. 2018 Dec 3. How is a serum sample collected for an immunofixation test? Immunofixation to identify the M component as an IgM immunoglobulin with a quantitative IgM level greater than 3 g/dL. On a computer screen, these proteins form a pattern of bands. Youve read {{metering-count}} of {{metering-total}} articles this month. 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. Immunofixation detects monoclonal proteins in serum and urine C-reactive protein (CRP) is located in the area between the beta and gamma components.1, Serum protein electrophoresis commonly is performed when multiple myeloma is suspected. Accessed April 18, 2019. Blood. Malabsorption; [updated 2019 Nov 11; cited 2019 Dec 10]; [about 2 screens]. But sometimes it can progress to more-serious diseases, including some forms of blood cancer. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. It can also detect changes in the ratio of kappa and lambda light chain production, which indicates an excess of abnormal plasma cells. Share cases and questions with Physicians on Medscape consult. When you arrive, a healthcare professional will simply use a needle to take a blood sample. This causes the different types of proteins to move and group together. Alexandria (VA): American Society of Clinical Oncology; 20052019. Serum protein electrophoresis is an inexpensive, easy-to-perform screening procedure for initial identification of monoclonal bands. High amounts of M protein in a person's blood or urine may be a sign they have multiple myeloma but the presence of M proteins could also indicate other types of plasma cell tumors. 25th ed. So when the Serum Protein Electrophoresis (SPEP) test shows a spike in M protein, this is a sign of MM. Urine immunofixation uses electricity to push proteins from your urine sample through a kind of gel. Proteins are substances made of small chemicals called amino acids. 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. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: leukemia; [cited 2019 Dec 10]; [about 3 screens]. MGUS causes no symptoms. The presence of oligoclonal bands in CSF but not in the serum, given their intrathecal production, is helpful in the diagnosis of multiple sclerosis. Protein electrophoresis serum : Overview; [updated 2021 Aug 9; cited 2021 Aug 9]; [about 2 screens]. 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. Immunoglobulins are proteins that function as antibodies, which fight infection. Exp Ther Med. It can also can vary in how that amount relates to the behavior of the myeloma. That criteria is determined by a pathologist who reviews the bone marrow aspirate slides. It's easier to check your kidney health at home now more than ever. This article provides a comprehensive review of serum protein electrophoresis, including a discussion of how the examination is performed, what it measures, and when it is indicated. Diagnostic Approach to Patients with an IgM Monoclonal Protein When these are removed, a liquid is left behind. Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel. Suspected multiple myeloma, Waldenstrms macroglobulinemia, primary amyloidosis, or related disorder, Unexplained peripheral neuropathy (not attributed to longstanding diabetes mellitus, toxin exposure, chemotherapy, etc. The Licensed Content is the property of and copyrighted by DSM. Monoclonal antibodies could be used as myeloma treatments and can be identified by serum protein electrophoresis and immunofixation electrophoresis. The M protein has an incomplete heavy chain and no light chain. Hematocrit is a blood test that is used to determine if you have low levels of hemoglobin in your blood (a condition called anemia).
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