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.

scholarly journals Immunoglobulin Pattern in Monoclonal Gammopathy Disorders

2020 ◽  
Vol 14 (2) ◽  
pp. 160-163
Author(s):  
Monwar Tarek ◽  
Latifa Rahman ◽  
Susane Giti ◽  
Md Abdul Wahab
Keyword(s):  
Serum Protein ◽  
Monoclonal Gammopathy ◽  
Armed Forces ◽  
Bone Marrow Examination ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Cross Sectional ◽  
Monoclonal Gammopathies ◽  
Medical College ◽  
Monoclonal Proteins

Introduction: The presence of abnormal monoclonal proteins, the M band, is a frequent characteristic feature of plasma cell dyscrasias and is usually detected as a discrete band in the γ or β region in serum or urine protein electrophoresis. It is characterized and confirmed by immunofixation electrophoresis (IFE). Accurate detection and quantification of monoclonal immunoglobulins are important for the diagnosis and management of monoclonal gammopathies. Objectives: To find out the pattern of immunoglobulin in monoclonal gammopathy cases and evaluate the role of IFE in the detection of them. Materials and Methods: This cross-sectional descriptive study was conducted in the Department of Haematology, Armed Forces Institute of Pathology (AFIP), Dhaka from July 2015 to December 2015. Thirty diagnosed cases of monoclonal gammopathies of both sexes were selected. Bone marrow examination, serum protein electrophoresis, skeletal survey, relevant biochemical test and IFE were performed for all the cases. Results: Out of 30 monoclonal gammopathy cases, M band was identified in 24(80%) cases by serum protein electrophoresis but by the IFE M band was found in all 30(100%) cases. Among the M band pattern of immunoglobulin was characterized by IFE and the result was; 15(50%) cases IgG Kappa, 09(30%) cases IgG Lambda, 02(6.7%) cases IgA Kappa, 02(6.7%) cases IgM Kappa and 02(6.7%) cases light chain kappa monoclonal protein. Conclusion: Though the number of the patient was limited, it is evident that in 20% gammopathy cases M band was missing by conventional serum protein electrophoresis but IFE could identify M band in all the cases. It is recommended that IFE should be carried out in all monoclonal gammopathy patients. Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 160-163

The Biologic and Analytic Variability of Serum Protein Electrophoresis M-Spike, Nephelometric Ig Quantitation, Serum FLC Quantitation, and Urine M-Spike in Monoclonal Gammopathies.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1803-1803
Author(s):  
Melissa Snyder ◽  
Angela Dispenzieri ◽  
S.Vincent Rajkumar ◽  
Robert Kyle ◽  
Joanne Benson ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Serum Protein ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Monoclonal Gammopathies ◽  
Number Of Patients ◽  
Measurable Disease ◽  
M Spike ◽  
Serial Samples ◽  
Serum And Urine

Abstract Abstract 1803 Poster Board I-829 Background Plasma cell proliferative disorders are monitored by a variety of methods. Serum protein electrophoresis (SPEP) and/or urine PEP M-spike quantitation are commonly assessed in patients with monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), and multiple myeloma (MM) to determine disease progression, response, or relapse. Serum immunoglobin (Ig) concentrations can be quantitated when the M-spike is large or if the migration is obscured within the SPEP beta fraction. Serum FLC quantitation provides a rapid indicator of response, will detect the rare occurrence of FLC escape, and will allow disease monitoring in the absence of a measurable serum or urine M-spike. The International Myeloma Working Group (IMWG) has recommended that the serum and urine M-spike should be used to monitor disease, and that FLC quantitation should be used only if there is no measurable disease by electrophoresis and if the monoclonal FLC concentration is greater than 10 mg/dL in the context of an abnormal FLC K/L ratio. We have studied serial samples in clinically stable patients in order to assess the total variability (analytic and biologic) of these assays and to confirm the IMWG recent recommendations. Methods Serial data from stable MGUS patients (n=35) were identified by the availability of all 3 serum test results (M-spike, Ig, FLC) in at least 4 serial samples that were obtained 9 months to 5 years apart and whose serum M-spikes varied by less than 25%. For MM (n=60) and SMM (n=48) the samples were within 9-15 months and serum M-spikes varied by less than 0.5 g/dL. Among the 60 MM, 48 SMM, and 35 MGUS patients, there were 23, 41, and 18 patients with measurable disease by serum M-spike (i.e. M-spike >1 g/dL); 19, 10, and 10 patients with an evaluable FLC (i.e. monoclonal FLC > 10 mg/dL and an abnormal FLC ratio); and 5, 5, and 1 patient with an evaluable urine (i.e. M-spike > 200mg/24 hr). The FLC data was analyzed as the involved FLC concentration (iFLC), the difference between the involved and uninvolved FLC concentration (dFLC), and the FLC K/L ratio (rFLC). The coefficients of variability (CV) were determined for each methodology in each patient sample set, and the average CVs were determined. Igs were quantitated by immunonephelometry using a Siemens BNII and Siemens reagent sets; kappa and lambda FLC were quantitated using a Siemens BNII and Freelite reagent sets from The Binding Site; M-spikes were quantitated using Helena SPIFE SPE and reagent sets. Results The CVs for the Ig quantitation, SPEP M-spike, FLC quantitation, and urine M-spike in each of the patient groups are listed in the table: Our laboratory's interassay analytic CV for replicate samples are 4-5% for Ig quantitation, 6-8% for SPEP M-spikes, 6-7% for FLC quantitation, and 5-7% for urine M-spikes. The analytic CVs of the methods are similar, but the total (analytic + biologic) CVs are very different. The samples have been selected by restricting the variability of serum M-spike values; when we apply the same criteria to the IgG quantitation, the IgG total CV comes closer to the serum M-spike CVs. The remaining differences, however, may be due to biologic variability contributed by polyclonal Ig. The total CV for iFLC is similar to the urine M-spike CV and suggests a previously unrecognized large biologic CV for serum FLC. The iFLC and dFLC CVs were comparable but were smaller than the rFLC CV. Conclusion The variability of the serum and urine M-spike, Ig, and FLC measurements confirm the IMWG recommendations for patient monitoring. If a patient has a measurable M-spike >1 g/dL, then the serum M-spike should be followed. If there is no measurable disease, then the iFLC can be monitored, provided that the rFLC is abnormal and the iFLC concentration is >10 mg/dL. Although the number of patients with evaluable urine M-spikes in this study is small, larger studies may confirm the utility of serum FLC compared to urine M-spike for monitoring patients with monoclonal gammopathies. Disclosures No relevant conflicts of interest to declare.

scholarly journals ELEKTROFORESIS PROTEIN SERUM PASIEN DENGAN KADAR PROTEIN NORMAL

2018 ◽  
Vol 15 (3) ◽  
pp. 87
Author(s):  
Tiene Rostini ◽  
Coriejati Rita
Keyword(s):  
Serum Protein ◽  
Total Protein ◽  
Protein Level ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Total Protein Level ◽  
Normal Limits ◽  
Nephritic Syndrome ◽  
Serum Protein Level ◽  
Electrophoresis Pattern

Serum protein electrophoresis pattern can assist in diagnosis of liver disease, hematological disorders, renal disorders andgastrointestinal disease. Measurement of total protein level in the serum cannot detect any disorders in patient with normal limit ofserum total protein level. The aim of this study; was to evaluate the serum protein electrophoresis pattern in patient with normal limitsof serum protein level. This research was carried out by descriptive retrospective study using the electrophoresis data from patients’medical record at the Clinical Pathology Department, Dr. Hasan Sadikin General Hospital Bandung. The data of serum electrophoresis (bySebia gel electrophoresis) were grouped based on disease or disorders, and confirmed with the diagnosis derived from patient’s medicalrecord. Inclusion criteria of samples if ; the electrophoresis data were available, serum total protein level within normal limits (6.4–8.3mg/dL), and the data of electrophoresis taken from medical record were taken from August 2006 until August 2008. The result foundso far was, there were 240 data of electrophoresis from patients with serum protein level within normal limits (6.4–8.3 mg/dL). theinterpretation of electrophoresis consist of: 1) inflammation (149 patients; 62.2% ; sensitivity 83.7%, specificity 86,5%) 2) Cirrhosis(46 patients ; 19.2% ; sensitivity 87.5% ; specificity 88.4%) 3) Nephritic syndrome (15 patients ; 6.2%; sensitivity 53%; specificity96.9% 4) Monoclonal gammophaty (15 patients(6.2% ; sensitivity 80% ; specificity 98.7%) 5) Normal pattern in 15 patient (6.2%).This study found abnormal serum protein electrophoresis pattern in the condition of inflammation, Cirrhosis, Nephritic Syndrome, andMonoclonal gammophaty. It can be concluded that many disorders could be detected in patient with serum protein level within normallimits such as: inflammation, cirrhosis, nephritis syndrome and monoclonal gammophaty by abnormal electrophoresis pattern

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.

Evaluation of the protein gap for detection of abnormal serum gammaglobulin level: an imperfect predictor

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Adam Suleman ◽  
D. William Cameron ◽  
Vicente Corrales-Medina ◽  
Christopher McCudden ◽  
Juthaporn Cowan
Keyword(s):  
Negative Predictive Value ◽  
Serum Protein ◽  
Total Protein ◽  
Predictive Value ◽  
Protein Electrophoresis ◽  
Serum Protein Electrophoresis ◽  
Likelihood Ratios ◽  
Paired Data ◽  
Predictive Values ◽  
Populations At Risk

AbstractObjectivesThe value of the serum protein gap (PG, difference between total protein and albumin) in the detection of hyper- or hypogammaglobulinemia is not well established. We assessed the performance of PG for the detection of hyper- or hypogammaglobulinemia in a large sample of patients.MethodsWe reviewed all paired measurements of serum total protein, albumin, quantitative immunoglobulins, and serum protein electrophoresis tested between March 2014 and June 2017 at the Eastern Ontario Regional Laboratory Association. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios of PG at thresholds between 18 and 44 g/L for the detection of hyper- and hypogammaglobulinemia were assessed.ResultsThere were 19,575 and 5,426 simultaneous paired data points to assess hyper- and hypogammaglobulinemia identified by serum protein electrophoresis (SPE) and nephelometry, respectively. The mean PG was 36.3 g/L (SD 8.6). The prevalence of hypergammaglobulinemia (>16 g/L by SPE) and hypogammaglobulinemia (IgG <7 g/L) was 21.9 and 5.5%, respectively. High PG (≥38 g/L) had sensitivity and specificity of 76.2 and 71.5% respectively for hypergammaglobulinemia. PG ≥38 g/L had a negative predictive value (NPV) of 93.1% for monoclonal, and 96.9% for polyclonal gammopathy. A PG threshold of ≤18 g/L had of sensitivity of 0.4%, specificity of 100%, PPV of 100% and NPV of 80.1% to detect hypogammaglobulinemia (IgG <7 g/L).ConclusionsHigh and low PG values were not sensitive in detecting hyper- or hypogammaglobulinemia, although negative predictive values were high for both. Performance of PG should be further evaluated prospectively in specific populations at risk of for abnormal IgG levels.

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.

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