Serum protein electrophoresis (SPEP) is a test that measures theantibodies in the blood and can find a monoclonal antibody. [13, 14], Diagnosis of plasma cell dyscrasias 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). PDF Understanding Your Lab Results - Myeloma Central 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. There are various types of these proteins that fight different types of infections. [10, 17], A 24-hour concentrated urine sample is appropriate for urine immunofixation. Morrow ES Jr. Allscripts EPSi. [Full Text]. The net charge (positive or negative) and the size and shape of the protein commonly are used in differentiating various serum proteins.1. 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. Once the serum samples are run on the analyzer, a technologist compares the curves with patients previous results and ensures the fractions are appropriately delineated. Serum free light chain testing provides complementary information to the two protein electrophoresis tests: SPEP and UPEP. Once a monoclonal gammopathy has been identified and a particular plasma cell proliferative disorder has been diagnosed, the quantification of the monoclonal protein is a good surrogate marker for monitoring the . Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Medscape Drugs & Diseases. Inflammatory diseases include. Please login or register first to view this content. However, you shouldnt have a lot of protein in your urine. The information on this site should not be used as a substitute for professional medical care or advice. Anastasios Dimou, MD Resident Physician, Department of Internal Medicine, Albert Einstein Medical CenterDisclosure: Nothing to disclose. The beta fraction has two peaks labeled beta1 and beta2. If you have questions about your results, talk to your health care provider. The identification of a monoclonal gammopathy depends on serum and urine protein electrophoresis and immunoelectrophoresis (IFE) 1 and/or quantitative free light chain assays. This content does not have an Arabic version. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant. High protein levels may be caused by many conditions. Kaplan JS, Horowitz GL. Efficacy and outcome of autologous transplantation in rare myelomas. MGUS causes no symptoms. Immunofixation detects monoclonal proteins in serum and urine No Monoclonal Protein in a Patient with CRAB Features Many subspecialists include serum protein electrophoresis screening in the initial evaluation for numerous clinical conditions. All rights reserved. On the left a serum protein electrophoresis (SPEP) of a patient with a monoclonal band in the gamma region is shown. The M protein has an incomplete heavy chain and no light chain. One pathologic reason which we covered at BCIT is a monoclonal gammopathy. Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. NGS can identify mutations present in the genes of the myeloma cells. [1] Serum or urine immunofixation negative for a monoclonal protein or a polyclonal pattern is considered to be normal. A normal result includes a darker immunoglobulin G (IgG) lane, a lighter immunoglobulin A (IgA), an absent immunoglobulin M (IgM), and a denser kappa compared to lambda lane, with ratio of 2:1. You may feel a little sting when the needle goes in or out. However, most patients with a monoclonal protein will be finally diagnosed with MGUS rather than any of the malignant plasma cell dyscrasias for which treatment is recommended. You are being redirected to This is serum. This allows them to be measured and analyzed individually. Urine Immunofixation: Symptoms, Treatment, and More - WebMD Under the PE Value it says: "SPE1". This sample is often difficult to collect, and suboptimal collection might alter the result. Mayo Clinic does not endorse companies or products. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. See permissionsforcopyrightquestions and/or permission requests. In addition, a beta2 microglobulin test, a CRP test, and a 24-hour urine collection for electrophoresis and immunofixation should be performed. 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. Posts: 33. Myeloma is a cancer of plasma cells, a type of white blood cell (WBC) in the bone marrow that is responsible for making immunoglobulins. This is a broad term encompassing a number of modern technologies that increase the speed and reduce the cost of DNA sequencing to look for mutations. Endoscopy vs. Colonoscopy: How Do They Differ? The LLS mission: Cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. There are a number of reasons why a doctor may order this test. The alpha2 component is increased as an acute-phase reactant. Flow Cytometry. UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): guidelines for the investigation of newly detected M-proteins and the management of monoclonal gammopathy of undetermined significance (MGUS). Autoinflammatory vs. Autoimmune: What is the Difference? If all tests are normal, the pattern of follow-up in Figure 36 can be undertaken. The five groups of proteins usually considered during an SPEP test are: Electrophoresis is a lab technique used to separate groups of proteins in blood serum. Ramakrishnan N, Jialal I. Bence-Jones Protein. How to get clearer test results on monoclonal antibodies Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel. Typically, the monoclonal protein is discovered, and workup then ensues. [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. Factors that increase your risk of developing MGUS include: Each year about 1% of people with MGUS go on to develop certain types of blood cancers or other serious diseases such as: Other complications associated with MGUS include bone fractures, blood clots and kidney problems. Complete Blood Count (CBC). Serum protein bands (monoclonal gammopathy) will sometimes be found following serum protein electrophoresis in patients presenting with classic signs or symptoms of multiple myeloma, e.g. Tax Identification Number: 13-5644916, Myeloma Guide: Information for Patients and Caregivers, A bone marrow aspirationto remove a liquid marrow sample, A bone marrow biopsyto remove a small amount of bone filled with marrow, Malignant plasma cells: Plasma cell level of >10% in a bone marrow biopsy sample, Unusually large amounts of monoclonal protein (called an M spike). Copyright 2017, 2013 Decision Support in Medicine, LLC. Its a useful skill to maintain, as technologists especially those on off-shifts or at smaller sites may still collect through their career(s). A colonoscopy is specifically used to look at the colon. The IFX test can also be used to study changes in the structure of normal. Hematology: Basic Principles and Practice. [Internet]. Your doctor tests your bone marrow to look for malignant plasma cells. There is less than 10 percent plasma cell involvement on bone marrow biopsy. Subsequent immunofixation with electrophoresis identified the monoclonal protein as an IgG antibody (paraprotein) with a lambda light chain (arrow). Blood Chemistry Tests. Consequently, urine protein electrophoresis is recommended in all patients suspected of having a plasma cell dyscrasia.10. Cytogenetic Analysis. Making sense of serum protein bands - Best Tests July 2011 - bpac Home Decision Support in Medicine LabMed, Monoclonal gammopathy of unknown significance (MGUS), Low concentration of monoclonal immunoglobulins (LCMI). Leukemia. What is the reference range of an immunofixation test? An immunofixation blood test, also known as protein electrophoresis, measures certain proteins in the blood. Imaging Tests. No abstract available. 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. laboratory tests, reference ranges, and understanding results, https://www.cancer.net/cancer-types/multiple-myeloma/diagnosis, https://www.cancer.net/cancer-types/multiple-myeloma/symptoms-and-signs, https://labtestsonline.org/tests/alpha-1-antitrypsin, https://labtestsonline.org/conditions/malabsorption, https://labtestsonline.org/conditions/malnutrition, https://labtestsonline.org/tests/protein-electrophoresis-immunofixation-electrophoresis, https://mainehealth.org/services/autoimmune-diseases-rheumatology/inflammatory-diseases, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/leukemia, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/lymphoma, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/multiple-myeloma, https://www.nhlbi.nih.gov/health-topics/blood-tests, https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753361, http://saidsupport.org/autoinflammatory-vs-autoimmune-what-is-the-difference, https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=immunofixation_blood, https://patient.uwhealth.org/healthwise/article/hw43650, What You Need to Know About Blood Testing, U.S. Department of Health and Human Services, Numbness or tingling in the face, arms and/or legs, Inflammatory diseases, a condition when the body's immune system attacks healthy tissues by mistake. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. 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. Further separation of protein subtypes is achieved by staining with an immunologically active agent, which results in immunofluorescence and immunofixation. Immunofixationconsists of an electrophoresis phase and a fixation phase. Available from: UW Health [Internet]. San Francisco: Said Support; c2013-2016. Join the BCIT conversation on social media. We look forward to connecting with you. 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. Your story might just end up on BCIT News. You can also contact us directly if you need to. There is very little risk to having a blood test. Finally, when several bands with sharp borders are seen after immunofixation in cerebrospinal fluid (CSF) but not in serum, the result is reported as positive for oligoclonal bands.