The efficiency of hypogammaglobulinemia reflex immunofixation electrophoresis in identifying monoclonal proteins

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S30-S30
Author(s):  
V Zanfagnin ◽  
P Petersen ◽  
S Ikoma ◽  
A Chambliss
Keyword(s):  
Diagnostic Yield ◽  
Protein Detection ◽  
Predictive Performance ◽  
Sample Population ◽  
Monoclonal Protein ◽  
Immunofixation Electrophoresis ◽  
M Spike ◽  
Monoclonal Proteins ◽  
Larger Sample

Abstract Introduction/Objective Hypogammaglobulinemia can be a common occurrence in disorders with monoclonal gammopathies. Because hypogammaglobulinemia may mask a monoclonal protein on serum protein electrophoresis (sPEP), its presence in the absence of a discernible M-spike is often the basis of reflexive testing by immunofixation electrophoresis (IFE). At our Institution, reflex IFE has historically been performed in cases where the gamma fraction on sPEP is <0.6 g/dL. The aim of this study was to test the predictive performance of hypogammaglobulinemia in identifying abnormal bands on IFE in newly screened patients. Methods/Case Report All patients that underwent sPEP testing from November 2020 to May 2021 at our Institution were identified. Among them, patients with gamma fraction <0.6 g/dL and no previous sPEP testing were included for analysis. Reflex IFE results were reviewed for identification of abnormal bands. Results (if a Case Study enter NA) Out of a total number of 1,374 patients tested for sPEP in the study period, 72 had serum gamma fraction <0.6 g/dL (5.2%). Among them, 36 patients had no previous sPEP testing, and their reflex IFE were reviewed. In 38.8% of the cases, the IFE showed one or more abnormal (monoclonal) bands. When considering a new threshold for hypogammaglobulinemia IFE reflex of <0.4 g/dL, the diagnostic yield for finding abnormal bands increased to 62.5%. Moreover, a percentage reduction of 64.2% was observed in the number of reflex IFE performed. Conclusion Although these data must be confirmed using a larger sample population, a lower threshold for hypogammaglobulinemia may be proposed at our Institution to reduce labor and costs and to improve efficiency of monoclonal protein detection.

scholarly journals Quantitation of Serum Monoclonal Proteins: Relationship between Agarose Gel Electrophoresis and Immunonephelometry

2009 ◽  
Vol 55 (8) ◽  
pp. 1523-1529 ◽  
Author(s):  
David L Murray ◽  
Euijung Ryu ◽  
Melissa R Snyder ◽  
Jerry A Katzmann
Keyword(s):  
Protein Quantification ◽  
Systematic Bias ◽  
Agarose Gel Electrophoresis ◽  
High Concentration ◽  
Linear Region ◽  
Monoclonal Protein ◽  
Immunofixation Electrophoresis ◽  
M Spike ◽  
Monoclonal Proteins ◽  
The Relationship

Abstract Background: Previous comparisons of monoclonal protein quantification identified a bias between serum protein electrophoresis (SPEP) and immunonephelometry (NEPH). Methods: We reviewed data from 2845 patients in whom a single sample provided a γ fraction M-spike by SPEP, a heavy chain isotype by immunofixation electrophoresis (IFE), and an Ig quantification by NEPH. We examined the relationship between SPEP and NEPH. Selected sera with high monoclonal protein concentrations were diluted and reassessed. Results: For all isotypes, the relationship between SPEP and NEPH was best fitted with cubic curves. We determined the concentrations of each isotype that fitted a linear relationship. IgA had the best correspondence (slope 0.92, 95% CI 0.87–1.02), whereas IgM demonstrated a systematic bias of higher values by NEPH (slope 1.80, 95% CI 1.68–1.92). IgG demonstrated a nonlinear relationship between SPEP and NEPH, with a linear region <19.2 g/L having a slope of 0.83 (95% CI 0.79–0.89) and a second linear region having a slope of 1.47 (95% CI 1.39–1.53) at higher concentrations. Dilutions of high-concentration IgG monoclonal proteins were linear by NEPH and nonlinear by SPEP. Conclusions: There are systematic differences in the quantification of monoclonal IgM and IgG by SPEP and NEPH. The bias in IgM is from NEPH overestimation. The nonlinearity of SPEP at high monoclonal IgG concentrations may obscure changes in plasma cell populations. Clinicians should be made aware of the biases and nonlinearity in these tests to make proper conclusions regarding treatment response.

scholarly journals Detection of κ and λ Light Chain Monoclonal Proteins in Human Serum: Automated Immunoassay versus Immunofixation Electrophoresis

2006 ◽  
Vol 13 (2) ◽  
pp. 277-280 ◽  
Author(s):  
Troy D. Jaskowski ◽  
Christine M. Litwin ◽  
Harry R. Hill
Keyword(s):  
Heavy Chain ◽  
Monoclonal Gammopathy ◽  
Protein Electrophoresis ◽  
Light Chains ◽  
Free Light Chains ◽  
Unknown Significance ◽  
Immunofixation Electrophoresis ◽  
M Spike ◽  
Automated Immunoassay ◽  
Monoclonal Proteins

ABSTRACT Recently, turbidimetric immunoassays for detecting and quantifying κ and λ free light chains (FLC) have become available and are promoted as being more sensitive than immunofixation electrophoresis (IFE) in detecting FLC monoclonal proteins. In this study, we assessed the ability of these turbidimetric assays to detect serum monoclonal proteins involving both free and heavy-chain-bound κ and λ light chains compared to standard immunofixation electrophoresis. Sera demonstrating a restricted band of protein migration (other than a definite M spike) by serum protein electrophoresis (SPE), which may represent early monoclonal proteins, were also examined. When compared to IFE, percent agreement, sensitivity, and specificity for the κ-FLC and λ-FLC were 94.6, 72.9, and 99.5% and 98.5, 91.4, and 99.7%, respectively, in detecting monoclonal proteins involving free and heavy-chain-bound light chains. The majority of sera (73.7%) demonstrating a restricted band of protein migration on SPE demonstrated abnormal IFE patterns suggestive of multiple myeloma or monoclonal gammopathy of unknown significance, but gave normal κ/λ FLC ratios using the turbidimetric immunoassays. In conclusion, the κ and λ FLC assays are significantly less sensitive (72.9 to 91.4%) than IFE, but specific in detecting serum monoclonal proteins. Moreover, the κ/λ ratio has little value in routine screening since the majority of sera with abnormal IFE patterns had normal κ/λ FLC ratios.

The Detection by Immunofixation Electrophoresis (IFE) of Monoclonal Proteins in Veteran Patients with Hypogammaglobulinemia on Negative Serum Protein Electrophoresis, the Veteran Affairs Medical Center (VAMC) Experience

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S89-S89
Author(s):  
J M Petersen ◽  
M Litman ◽  
R Millili ◽  
D Jhala
Keyword(s):  
Serum Protein ◽  
Medical Center ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Time Analysis ◽  
Improvement Project ◽  
Immunofixation Electrophoresis ◽  
M Spike ◽  
Monoclonal Proteins ◽  
First Time

Abstract Introduction/Objective Serum protein electrophoresis (SPEP) is the backbone laboratory test for the detection of abnormal monoclonal proteins. However, IFE is a sensitive assay that can sometimes detect monoclonal proteins even when the corresponding SPEP is negative. The fact that IFE is more sensitive than SPEP combined with the need to avoid overutilization of IFE has led to published algorithms for guidance. Hypogammaglobulinemia in a new patient has been recognized in these algorithms as a reason to reflex to IFE when SPEP is negative, though studies on veteran patients are sparse. Therefore, this QA study of the percentage of positive IFEs in negative new SPEP veteran patients with hypogammaglobulinemia was undertaken to ensure reflex IFEs would still be indicated. Methods As part of a quality assurance/quality improvement project, a retrospective Vista/Fileman search of all SPEPs with IFE performed from January 2017 to February 2019 was undertaken to identify cases of SPEPs showing hypogammaglobulinemia (<0.7 g/dL). Diagnostic comments were then analyzed to identify cases of hypogammaglobulinemia along with the M-spike (<0.1 g/dL) to identify negative SPEPs. Only those cases that were consistent with first time hypogammaglobulinemia without an obvious M-spike were included and tabulated for calculations. Any result that was not negative for a monoclonal band was considered as positive. Results There were a total of 194 specimens that met the criteria of SPEP with hypogammaglobulinemia and standard comments consistent with first time analysis and without an obvious M-spike on SPEP. Out of these 194 specimens, 45 had a positive result, either as a monoclonal band comigrating with the beta protein peak or as a very faint gamma or beta monoclonal band. This represented approximately 23% of the specimens, about double the literature published rate for the non-veteran population. Conclusion The performance of IFE on new hypogammaglobulinemia veteran patients appears to be indicated like previously published algorithms and is supported by the fact that about double (23%), compared to the non-veteran population, had positive IFEs despite negative SPEPs. IFE is a helpful tool for new hypogammaglobulinemia patients for the detection of monoclonal proteins despite negative SPEPs.

scholarly journals Serum free light chain assay reduces the need for serum and urine immunofixation electrophoresis in the evaluation of monoclonal gammopathy

2009 ◽  
Vol 46 (5) ◽  
pp. 407-412 ◽  
Author(s):  
Richard B Fulton ◽  
Suran L Fernando
Keyword(s):  
Light Chain ◽  
Monoclonal Gammopathy ◽  
Free Light Chain ◽  
Light Chains ◽  
Serum Free ◽  
Monoclonal Protein ◽  
Serum Free Light Chain ◽  
Immunofixation Electrophoresis ◽  
Monoclonal Proteins ◽  
Testing Algorithm

Background The potential for serum free light chain (sFLC) assay measurements to replace urine electrophoresis (uEPG) and to also diminish the need for serum immunofixation (sIFE) in the screening for monoclonal gammopathy was assessed. A testing algorithm for monoclonal protein was developed based on our data and cost analysis. Methods Data from 890 consecutive sFLC requests were retrospectively analysed. These included 549 samples for serum electrophoresis (sEPG), 447 for sIFE, and 318 for uEPG and urine immunofixation (uIFE). A total of 219 samples had sFLC, sEPG, sIFE and uEPG + uIFE performed. The ability of different test combinations to detect the presence of monoclonal proteins was compared. Results The sFLC κ/ λ ratio (FLC ratio) indicated monoclonal light chains in 12% more samples than uEPG + uIFE. The combination of sEPG and FLC ratio detected monoclonal proteins in 49% more samples than the combination of sEPG and sIFE. Furthermore, the sEPG + FLC ratio combination detected monoclonal protein in 6% more samples than were detected by the combined performance of sEPG, sIFE, uEPG and uIFE. However, non-linearity of the assay, the expense of repeat determinations due to the narrow measuring ranges, and frequent antigen excess checks were found to be limitations of the sFLC assay in this study. Conclusion The FLC ratio is a more sensitive method than uIFE in the detection of monoclonal light chains and may substantially reduce the need for onerous 24 h urine collections. Our proposed algorithm for the evaluation of monoclonal gammopathy incorporates the sFLC assay, resulting in a reduction in the performance of labour intensive sIFE and uEPG + uIFE while still increasing the detection of monoclonal proteins.

scholarly journals Monitoring IgA Multiple Myeloma: Immunoglobulin Heavy/Light Chain Assays

2015 ◽  
Vol 61 (2) ◽  
pp. 360-367 ◽  
Author(s):  
Jerry A Katzmann ◽  
Maria A V Willrich ◽  
Mindy C Kohlhagen ◽  
Robert A Kyle ◽  
David L Murray ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Light Chain ◽  
Clinical Laboratory ◽  
Reference Interval ◽  
Reference Intervals ◽  
Additional Advantage ◽  
Immunofixation Electrophoresis ◽  
Diagnostic Samples ◽  
M Spike ◽  
Monoclonal Proteins

Abstract BACKGROUND The use of electrophoresis to monitor monoclonal immunoglobulins migrating in the β fraction may be difficult because of their comigration with transferrin and complement proteins. METHODS Immunoassays specific for IgGκ, IgGλ, IgAκ, IgAλ, IgMκ, and IgMλ heavy/light chain (HLC) were validated for use in the clinical laboratory. We assessed sample stability, inter- and intraassay variability, linearity, accuracy, and reference intervals for all 6 assays. We tested accuracy by verifying that the sum of the concentrations for the HLC-pairs accounted for the total immunoglobulins in each of 129 healthy sera, and that the HLC-pair ratios (rHLCs) were outside the reference interval in 97% of 518 diagnostic multiple myeloma (MM) samples. RESULTS We assessed diagnostic samples and posttreatment sera in 32 IgG and 30 IgA patients for HLC concentrations, rHLC, and total immunoglobulins and compared these nephelometry results with serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE). In sample sets from patients with IgG MM, the sensitivity of SPEP was almost the same as for rHLC, and no additional advantage was conferred by running HLC assays. In pre- and posttreatment samples from patients with IgA MM, the SPEP, rHLC, and IFE identified clonality in 28%, 56%, and 61%, respectively. In addition, when M-spikes were quantifiable, the concentration of the involved HLC was linearly related to that of the SPEP M-spike, with a slope near 1. CONCLUSIONS The use of IgA HLC assays for monitoring β-migrating IgA monoclonal proteins can substitute for the combination of SPEP, IFE, and total IgA quantification.

scholarly journals Natural language processing (NLP) tools in extracting biomedical concepts from research articles: a case study on autism spectrum disorder

2020 ◽  
Vol 20 (S11) ◽  
Author(s):  
Jacqueline Peng ◽  
Mengge Zhao ◽  
James Havrilla ◽  
Cong Liu ◽  
Chunhua Weng ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Clinical Manifestations ◽  
Predictive Performance ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Research Articles

Abstract Background Natural language processing (NLP) tools can facilitate the extraction of biomedical concepts from unstructured free texts, such as research articles or clinical notes. The NLP software tools CLAMP, cTAKES, and MetaMap are among the most widely used tools to extract biomedical concept entities. However, their performance in extracting disease-specific terminology from literature has not been compared extensively, especially for complex neuropsychiatric disorders with a diverse set of phenotypic and clinical manifestations. Methods We comparatively evaluated these NLP tools using autism spectrum disorder (ASD) as a case study. We collected 827 ASD-related terms based on previous literature as the benchmark list for performance evaluation. Then, we applied CLAMP, cTAKES, and MetaMap on 544 full-text articles and 20,408 abstracts from PubMed to extract ASD-related terms. We evaluated the predictive performance using precision, recall, and F1 score. Results We found that CLAMP has the best performance in terms of F1 score followed by cTAKES and then MetaMap. Our results show that CLAMP has much higher precision than cTAKES and MetaMap, while cTAKES and MetaMap have higher recall than CLAMP. Conclusion The analysis protocols used in this study can be applied to other neuropsychiatric or neurodevelopmental disorders that lack well-defined terminology sets to describe their phenotypic presentations.

scholarly journals Using tropicamide and phenylephrine without cyclopentolate for pupil dilation in cataract surgery reduces postoperative intraocular pressure rise

2020 ◽  
Vol 17 (3) ◽  
pp. 285-289
Author(s):  
Rachel Xuan ◽  
Keith Ong
Keyword(s):  
Intraocular Pressure ◽  
Retrospective Study ◽  
Cataract Surgery ◽  
Medical Records ◽  
Pressure Rise ◽  
Pupil Dilation ◽  
The Other ◽  
Sample Population ◽  
Iop Elevation ◽  
Larger Sample

The aim of this retrospective study was to evaluate whether intraocular (IOP) elevation post-cataract surgery can be reduced by using tropicamide and phenylephrine only, without cyclopentolate. Medical records across two surgical facilities were analyzed. One surgical facility (Cohort A) used a combination of tropicamide, cyclopentolate, and phenylephrine preoperatively, while the other (Cohort B) used tropicamide and phenylephrine only. Of patients in Cohort A, 63.6% (n = 7) had a higher IOP in the operated eye, while it was only 27.3% (n = 3) in Cohort B. Therefore, it is preferable to exclude the use of cyclopentolate in the preoperative dilation regimen of patients undergoing cataract surgery. However, a study with a larger sample population is required to further evaluate the significance of these results.

scholarly journals Environmental Education as a Tool for Sustainable Development: Case study of Lekki-Lagos

2017 ◽  
Vol 1 (1) ◽  
pp. 15-22
Author(s):  
M. N. Chukwu ◽  
S. J. Kadafur
Keyword(s):  
Environmental Education ◽  
Sample Population ◽  
Traffic Jam ◽  
Qualitative Survey ◽  
Private Organizations ◽  
Pedestrian Bridges ◽  
Significant Difference ◽  
Grass Root ◽  
The Government

The study examines the strength of environmental education in Lekki-Lagos and its impact on community and grass-root development by considering a targeted sample population comprising some respondents that are living or working in Lekki community in Lagos. A qualitative survey was conducted using participatory observation, interviews, and a structured questionnaire. The questionnaire was validated through peer review and pilot testing. Data collected were summarized and computed using descriptive statistics while a paired t-test and Turkey’s HSD test were used for further analysis. Results showed that 92% of the respondents affirmed that environmental education impacted positively on the community attracting the government, non-governmental and private organizations to help in developing the area through construction of roads, pedestrian bridges, drainages and sea embankments thus reducing flooding, man hour loss due to traffic jam and rate of pollution. There was also a decrease in loss of lives and properties. Investors were attracted to Lekki, reducing poverty and social imbalance thus increasing community development. There is a significant difference between the state of Lekki now and before the intervention of public-private practice in developing the area (P< 0.05). It is recommended that the government and other stakeholders should collaborate on a higher scale to enhance developing the unreached communities.

scholarly journals Predictive Performance of Hargreaves Model in Estimating Solar Radiation in Yola, Adamawa State Nigeria Using Minimum Climatological Data

2018 ◽  
pp. 1-8
Author(s):  
Ojo Samuel ◽  
Alimi Taofeek Ayodele ◽  
Amos Anna Solomon
Keyword(s):  
Solar Radiation ◽  
Model Performance ◽  
Predictive Performance ◽  
Global Solar Radiation ◽  
Climatic Data ◽  
Climatological Data ◽  
University Of Technology ◽  
Hargreaves Model ◽  
The Many

Mathematical models have been very useful in reducing challenges encountered by researchers due to the inability of having solar radiation data or lack of instrumental sites at every point on the Earth.  This work aimed at investigating the prediction performance of Hargreaves-Samani’s model in estimating global solar radiation (GSR) out of the many other empirical models so far formulated for this purpose. This model basically uses maximum and minimum temperature data and basically used in mid-latitudes. The paper attempts to assess the predictive performance of Hargreaves-Samani’s model in the Savanna region using Yola as a case study. Estimated values of GSR from one month data adopted from the Meteorological station of the Department of Geography, Federal University of Technology, Yola, Nigeria was used for this purpose. Using this model shows a 95% index of agreement (IA) with the observed values; which suggests a good model performance and can also be used in estimating global solar radiation in the Savanna region particularly in areas with little or no such climatic data.

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