scholarly journals Monoclonal gammopathy with double M-bands: An atypical presentation on serum protein electrophoresis simulating biclonal gammopathy

2017 ◽  
Vol 60 (4) ◽  
pp. 590
Author(s):  
Kaustubh Bora ◽  
Umesh Das ◽  
Bhupen Barman ◽  
AliceAbraham Ruram
Keyword(s):  
Serum Protein ◽  
Monoclonal Gammopathy ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Atypical Presentation ◽  
Biclonal Gammopathy

scholarly journals Usefulness of serum globulin levels for discriminating patients with monoclonal gammopathies/ paraproteinemias

Biomedicine ◽  
2021 ◽  
Vol 41 (1) ◽  
pp. 31-35
Author(s):  
Neelam M Pawar ◽  
Anupama Hegde
Keyword(s):  
Serum Protein ◽  
Total Protein ◽  
Monoclonal Gammopathy ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Serum Globulin ◽  
Protein Ratio ◽  
Monoclonal Gammopathies ◽  
Median Serum ◽  
Control Study

Introduction and Aim: The confirmatory step in diagnosis of monoclonal gammopathies is bone marrow biopsy and presence of M-protein in serum protein electrophoresis. These tests are relatively expensive & invasive for screening and unavailable in low resource settings. Increased levels of serum globulin are clue to the diagnosis of monoclonal gammopathy. The aim of this study was to assess the relevance of serum globulin levels in discriminating between patients with & without monoclonal gammopathies/ paraproteinemia. Materials and Methods: We retrospectively reviewed serum protein electrophoresis (SPE) and related investigations of patients suspected of monoclonal gammopathy. Reports with an M-band were considered as paraproteinemias, and those without as controls. ROC for sensitivities & specificities for serum globulin levels were computed. Results: For the case-control study, median serum globulin values in cases were 4.4 (3.5-6.3) g/dL in males and 3.65 (3.33-5.0) g/dL in females. They were significantly higher than those with normal SPE pattern, with a p <0.001. A cut-off value of 3.25 g/dL of globulin could distinguish between paraproteinemias and controls with a sensitivity of 82.1% and specificity of 85.4% in males; a sensitivity of 79.2%, a specificity of 76.7% for females. At a cut-off value of 3.4 g/dL, sensitivity was 77% and specificity 92.7% for males; sensitivity was 75% and specificity 83.7% for females. Alternatively, a cut-off value of 0.458 of globulin/total protein ratio could distinguish at a best sensitivity & specificity of 80% and 89% in males; 83.3% and 83.7% in females. Conclusion: Serum globulin values and globulin/total protein ratio can reliably differentiate patients with paraproteinemias.

A comparison between high resolution serum protein electrophoresis and screening immunofixation for the detection of monoclonal gammopathies in serum

2018 ◽  
Vol 56 (2) ◽  
pp. 256-263 ◽  
Author(s):  
Joel Smith ◽  
Geoffrey Raines ◽  
Hans-Gerhard Schneider
Keyword(s):  
High Resolution ◽  
Sensitivity And Specificity ◽  
Serum Protein ◽  
Light Chain ◽  
Monoclonal Gammopathy ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Agarose Gel ◽  
Serum Free ◽  
Monoclonal Gammopathies

Abstract Background: There are a variety of initial laboratory tests or combinations of tests that can be performed when a monoclonal gammopathy is suspected including serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), serum immunofixation (IFE) and serum free light chain assays. Some groups have recently used simplified “screening” IFE methods for the detection of monoclonal gammopathies leveraging the greater sensitivity of IFE over SPEP alone to improve the detection of monoclonal gammopathies. These screening techniques have been predominantly evaluated against lower resolution agarose gel electrophoresis techniques. Methods: In this study we evaluated the diagnostic performance of the combined κ and λ light chain screening immunofixation (CLIF) in comparison to serum protein electrophoresis on a high-resolution (Sebia Hydragel 15 HR) agarose gel system. Each gel was interpreted by three adjudicators. A total of 156 patient samples were analysed. Adjudicated diagnoses based on the screening techniques were compared against the results of high resolution serum protein electrophoresis and high resolution standard immunofixation performed during routine laboratory operation. Where standard immunofixation was not performed a combination of a review of medical records, serum free light chains, UPEP and bone marrow aspirate and trephine and subsequent standard immunofixation and protein electrophoresis results where available were used to confirm the absence of a monoclonal gammopathy. Results: In this cohort a total of 65 (41%) patients had a paraprotein confirmed by standard immunofixation. HR SPEP had a sensitivity and specificity of 95% and 85%, respectively, while CLIF had a sensitivity and specificity of 88% and 97%, respectively. Conclusions: Overall we found that high-resolution gel serum protein electrophoresis using a Sebia Hydragel 15 HR system was more sensitive than a screening immunofixation method (CLIF) for the detection of paraproteins in patient serum in this patient cohort. The drawback of the greater sensitivity of HR SPEP was a higher false positive rate requiring an increased utilisation of follow up immunofixation electrophoresis.

Pyoderma Gangrenosum and IgA Myeloma

1997 ◽  
Vol 2 (2) ◽  
pp. 100-103 ◽  
Author(s):  
J. Mark Jackson ◽  
Jeffrey P. Collen
Keyword(s):  
Multiple Myeloma ◽  
Serum Protein ◽  
Pyoderma Gangrenosum ◽  
Monoclonal Gammopathy ◽  
Systemic Disease ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Potential Association ◽  
Uncommon Condition

Background: Pyoderma gangrenosum (PG) is an uncommon condition that is associated with a systemic disease in 50% of patients. The condition may be associated with a monoclonal gammopathy, usually of the IgA type. It is rare for PG to be associated with multiple myeloma. Observations: We report the case of an 83-year-old man with PG associated with an IgA myeloma. The myeloma was discovered after the diagnosis of PG had been made. This is the 22nd case of multiple myeloma associated with PG, and only the 14th case of PG with an IgA myeloma. Conclusions: We should be aware of the potential association of multiple myeloma with PG, and consider doing a serum protein electrophoresis in the evaluation of patients with PG.

In vitro evaluation of potential interference of lokivetmab with protein electrophoresis and immunofixation

2021 ◽  
Vol 49 (04) ◽  
pp. 278-283
Author(s):  
Neoklis Apostolopoulos ◽  
Athanasia Mitropoulou ◽  
Gesine Foerster ◽  
Klaus Failing ◽  
Andreas Moritz ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Serum Protein ◽  
Monoclonal Gammopathy ◽  
Reference Interval ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Before And After ◽  
Immunofixation Electrophoresis ◽  
Therapeutic Monoclonal Antibodies

Abstract Objective In humans, misdiagnoses of monoclonal gammopathy after use of therapeutic monoclonal antibodies has been documented. This triggers concerns for similar misdiagnoses in animals treated with monoclonal antibodies. The aim of this study was to evaluate if lokivetmab interferes with serum protein electrophoresis and immunofixation electrophoresis in dogs. Material and methods Residual sera from 25 client-owned, healthy blood donor dogs from 2 veterinary hospitals in Germany were used. The residual sera were analysed with serum protein electrophoresis and immunofixation electrophoresis before and after being spiked with lokivetmab at a concentration of 10 µg/ml (corresponding to the mean peak serum concentration after a subcutaneous injection of 2 mg/kg lokivetmab). Results No monoclonal gammopathy was observed on serum protein electrophoresis and all proteins had a normal distribution pattern without any pathologic bands on immunofixation electrophoresis. The absolute γ-globulin values of spiked samples, however, were significantly higher than in the native sera although they remained within the reference interval. No other globulin fractions were significantly different. Conclusion and clinical relevance This study suggests that lokivetmab at a dose of 2 mg/kg is not detected as a monoclonal peak on serum protein electrophoresis or immunofixation electrophoresis, and thus is unlikely to lead to a misdiagnosis of other diseases that are characterised by monoclonal gammopathies.

Determining Why and Which Clinicians Order Serum Protein Electrophoresis (SPEP), Subsequent Diagnoses Based On Indications, and Clinical Significance of Routine Follow-up: a Study of Patients with Monoclonal Gammopathy of Undetermined Significance (MGUS).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4883-4883 ◽  
Author(s):  
Leah M Doyle ◽  
Jacob D Gundrum ◽  
John P. Farnen ◽  
Linda J. Wright ◽  
Jo Ann I Kranig ◽  
...  
Keyword(s):  
Malignant Transformation ◽  
Clinical Significance ◽  
Serum Protein ◽  
Monoclonal Gammopathy ◽  
Conflicts Of Interest ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Number Of Patients ◽  
Malignant Transformations

Abstract Abstract 4883 Background MGUS is considered an incidental finding in the diagnostic work-up for multiple myeloma (MM) and related malignancies. Biologically, MGUS precedes all MM; however, its clinical significance and the utility of annual follow-up of these patients remain unknown. We studied a large series of MGUS patients to determine why clinicians ordered serum protein electrophoresis (SPEP) that resulted in an MGUS diagnosis, the subsequent diagnoses found based on test indications, and how malignant transformations are found. Methods Using our electronic medical database, we identified all MGUS patients diagnosed from January 1995-May 2009 at our institution. We excluded those who developed malignant transformation within 2 years of MGUS diagnosis. We reviewed the medical records to confirm the diagnosis and obtained relevant clinical data. To determine the likelihood of clinicians diagnosing a malignancy as a result of ordering SPEP, in recent years, we retrieved the number of patients with SPEP performed from 2004-2008 for indications other than follow-up of previously diagnosed MGUS, MM, and related malignancies. Results We found 361 MGUS patients with a median age at diagnosis of 74 years (range, 27-96). Fifty four percent were men and the median follow up time was 3 years (range, 0-37). The most common indications for monoclonal gammopathy testing were anemia (44%), bone symptoms/signs (20%), high creatinine (19%), elevated erythrocyte sedimentation rate (13%), and neuropathy (12%). Fifty-nine percent of patients had only 1 indication, 31% had 2 indications, and 10% had 3 or more indications. The departments that most commonly diagnosed MGUS were internal medicine (30%), hematology (19%), nephrology (11%), family practice (10%), and neurology (9%). The most common subsequent diagnoses were etiology unknown (22%), kidney disease (21%), chronic inflammation (12%), autoimmune conditions (9%), and iron deficiency (7%). The indications associated with an unknown diagnosis were anemia (38%), neuropathy (20%), and bone symptoms/signs (18%). Fifteen (4%) MGUS patients developed MM or a related malignancy at a median time of 4 years (range, 2-28). Of the transformations, 60% were detected because of symptoms and 40% were detected at scheduled MGUS follow-up. Of the 6 patients with malignant transformations detected at follow-up, 2 required treatment within a month of diagnosis, while 4 patients were observed for at least 6 months before initiating treatment. In 2004-2008, 7,090 patients had SPEP's performed to look for conditions associated with monoclonal gammopathy. This resulted in the diagnoses of 179 (3%) MGUS's and 89 (1%) malignancies. Conclusions At our institution, clinicians have a low threshold looking for malignancies associated with monoclonal gammopathy when evaluating elderly patients presenting with symptoms or signs seen in these conditions. This is despite the extremely low likelihood of finding one. For patients incidentally found to have MGUS, the rate of malignant transformation was low as expected; however, majority of transformations were found due to symptomatic presentations outside of scheduled follow-up visits. Our study calls into question the utility of the current practice of routinely following patients with MGUS. Disclosures No relevant conflicts of interest to declare.

scholarly journals Superiority of Serum Immunofixation Electrophoresis over Serum Protein Electrophoresis in the Diagnosis of Multiple Myeloma

2018 ◽  
Vol 36 (3) ◽  
pp. 95-100
Author(s):  
Mohammed Mosleh Uddin ◽  
Md Mizanur Rahman ◽  
Syeda Adib Sultana ◽  
Debashish Saha
Keyword(s):  
Multiple Myeloma ◽  
Serum Protein ◽  
Monoclonal Gammopathy ◽  
Plasma Cells ◽  
Cell Lineage ◽  
Armed Forces ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Suspected Case ◽  
Immunofixation Electrophoresis

Background: Multiple Myeloma (MM) is a neoplasm of B cell lineage characterized by excessive proliferation of abnormal plasma cells, secreting abnormal immunoglobulin causing monoclonal gammopathy which can be detected by the presence of M protein in serum and urine electrophoresis.Aim: Present study is aimed to detect and quantify monoclonal gamma globulins by SPEP and IFE in suspected case of MM and other plasma cell dyscrasias and also to find out the discrepant findings between SPEP and IFE.Methods: A retrospective observational study was carried out on clinically highly suspected cases of Multiple Myeloma (MM) presenting with backache, asthenia and generalized weakness at Armed forces Institute of Pathology(AFIP), Dhaka cantonment from January 2015 to July 2016. A total of 140 blood samples were collected and subjected to serum protein electrophoresis (SPEP) and Immunofixation electrophoresis (IFE). IFE identifies the type of heavy (IgG, IgM or IgA) and light chain (either kappa or lambda in suspected cases of MMResults: Out of 140 cases, SPEP identified monoclonal band in 62 cases and either non-specific findings or polyclonal band in 78 cases. At the same time immunofixation electrophoresis (IFE) which was done on all samples detected another 14 cases of M-band in addition to earlier 62 cases of monoclonal gammopathy by SPEP. Among 140 cases, SPEP detected M-band in 62 cases, whereas IFE identified monoclonal band in 76 cases. So in the remaining 14 cases (10%) small sharp spikes of monoclonal band was found only by IFE whereas SPEP failed to detect those 14 cases.Conclusion: SPEP is an easy to perform laboratory test which can be used for detection and quantification of monoclonal gammopathy but there is some limitation in detecting monoclonal band by SPEP. IFE is more sensitive to detect the monoclonal band than SPEP. So both SPEP and IFE should be done simultaneously for precise diagnosis of MM and related disorders.J Bangladesh Coll Phys Surg 2018; 36(3): 95-100

scholarly journals MP8: MONOCLONAL GAMMOPATHY CHARACTERIZATION USING SERUM PROTEIN ELECTROPHORESIS IN A MAJOR URBAN POPULATION

2016 ◽  
Vol 64 (3) ◽  
pp. 807.2-808
Author(s):  
DB Laskar ◽  
K Shafique ◽  
C Lu ◽  
A Zuretti
Keyword(s):  
Serum Protein ◽  
Monoclonal Gammopathy ◽  
Clinical Laboratory ◽  
Univariate Analysis ◽  
Group Versus ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Female Ratio ◽  
Wide Range ◽  
Hiv Aids

Purpose of StudySerum protein electrophoresis (SPEP) with subsequent immunofixation (IF) are clinical laboratory techniques used to evaluate a wide-range of disorders where abnormal serum protein quantities are characteristic (e.g. multiple myeloma (MM), MGUS, amyloidosis, HIV/AIDS, SLE, CLL/NHL). Thus, it is important to identify or exclude malignancy when considering the analyses. Our aim is to characterize SPEP patients from our institution, a predominantly black population.Methods UsedWe retrospectively reviewed 50 patient's SPEP/IF results. Data recorded were SPEP/IF results, monoclonal immunoglobulin (Ig) identity, clinical diagnoses, age, race and gender. Univariate analysis was used to describe patient demographics. Parametric analysis was used to compare the monoclonal gammopathy (MG) group versus non-MG group.Summary of ResultsAge range was 12–86 years, mean age was 62 years and male to female ratio was 1:3.5. Forty-eight (96%) patients identify as black, 1 (2%) Asian and 1 (2%) white. SPEP patterns showed 1 (2%) patient had acute inflammation, 3 (6%) had chronic inflammation, 24 (48%) were inconclusive, 16 (32%) had MGs, 3 (6%) had normal results and 3 (6%) had polyclonal bands (table 1). Among MG patients, IgG was most common isotype (75%), kappa was most common light chain (58%) and IgG kappa was most common (44%). Mean age was 69 years for MG patients and 58 years for non-MG patients.MM was identified in 9 (18%) patients; 89% (8/9) had normal total protein (TP) levels and 1 (11%) had increased TP. Neuropathy was seen in 7 (14%) patients; 71% (5/7) had polyclonal gamma Ig increase, and 1 (14%) case with co-HIV infection had monoclonal IgG kappa. Seven (14%) patients had CKD, 4 (8%) had HIV/AIDS, 3 (6%) had anemia, 3 (6%) had MGUS, 1 (2%) had SLE and the remaining 16 (32%) had other co-morbidities (i.e. HTN, DM, CAD, etc.).ConclusionsSPEP/IF analyses were used to characterize 50 patients. A wide-range of disorders were observed. MG patients were 11 years older than non-MG patients. IgG kappa was most common MG. Our study showed female-predominance. This study shows SPEP utility to discern various disorders observed at our institution.Abstract MP8 Figure 1

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