Malignant plasma cells in the bone marrow 10% or presence of bony or extramedullary plasmacytoma, confirmed by biopsy. In: Ferri's Clinical Advisor 2019. Please confirm that you would like to log out of Medscape. Electrophoresis is a lab technique used to separate groups of proteins in blood serum. We want you to take advantage of everything Cancer Therapy Advisor has to offer. 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Share cases and questions with Physicians on Medscape consult. Bone Marrow Tests. 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. Cavuoti D, Baskin L, Jialal I. Evidence of end-organ damage as defined by the CRAB criteria. This process is known as electrophoresis. Other names: serum protein electrophoresis, (SPEP), protein electrophoresis, SPE, immunofixation electrophoresis, IFE, serum immunofixation. Monoclonal gammopathy of undetermined significance (MGUS). The Leukemia & Lymphoma Society is a 501(c)(3) organization, and all monetary donations are tax deductible to the fullest extent allowed by tax laws. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Myeloma Protein (M Protein): What Is It? | MyMyelomaTeam Serum protein electrophoresis is an inexpensive, easy-to-perform screening procedure for initial identification of monoclonal bands. 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. Monoclonal gammopathy of undetermined significance (MGUS) is a condition in which an abnormal protein known as monoclonal protein or M protein is in your blood. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly. Medscape Education, 20022007195-overviewDiseases & Conditions, encoded search term (Immunofixation) and Immunofixation, Fast Five Quiz: Key Aspects of Multiple Myeloma, Fast Five Quiz: Multiple Myeloma Management, Fast Five Quiz: Relapsed/Refractory Multiple Myeloma, From War-Torn Beirut to Myeloma Research in NY, Bispecific Antibody Provides Durable Remission in Myeloma, Pathology of Mantle Cell Lymphoma: Biopsies, Diagnostic Markers, and Options for Clinicians Treating This Disease, CAR T-Cell Therapy for Relapsed/Refractory Multiple Myeloma. An immunofixation blood test, also known as protein electrophoresis, measures certain proteins in the blood. A serum free light chain ratio is indicated in the case of a negative immunofixation result when the suspicion for multiple myeloma is still high. There is very little risk to having a blood test. Serum is placed on a specific medium, and a charge is applied. See additional information. Available from: National Cancer Institute [Internet]. It's easier to check your kidney health at home now more than ever. [QxMD MEDLINE Link]. There are two main types of proteins in the blood: albumin and globulin. Accessed April 18, 2019. Some people may experience a rash or nerve problems, such as numbness or tingling. 5 fractions are shown in this image: albumin, alpha-1 (1), alpha-2 (2), beta () and gamma (). When a narrow band with sharp borders can be identified, it implies the presence of a monoclonal protein (see image below). In this case, the IgM lane, which is normally absent, is broad with smooth borders. 2018 Dec 3. Protein electrophoresis alone is not considered an adequate screen for monoclonal gammopathies. Heavy/light chain specific immunoglobulin ratios provides no additional information than serum proteins electrophoresis and immunofixation for the diagnosis and the follow-up of intact immunoglobulin multiple myeloma patients. CancerTherapyAdvisor.com is a free online resource that offers oncology healthcare professionals a comprehensive knowledge base of practical oncology information and clinical tools to assist in making the right decisions for their patients. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process, and they usually are associated with nonmalignant conditions. Available from: Lab Tests Online [Internet]. Youve read {{metering-count}} of {{metering-total}} articles this month. For patients with MGUS and high risk for progression to multiple myeloma, surveillance should be performed at 6 months and then yearly thereafter. A monoclonal protein is produced by the abnormal, cancerous or precancerous cells. Serum Protein Electrophoresis (SPEP) Test; [cited 2021 Aug 9]; [about 3 screens]. 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. Please login or register first to view this content. In myeloma, large amounts of a single antibody are noted as a monoclonal immunoglobulin spike or monoclonal spike (M spike), indicating that the protein came from cells that originally started as single, malignant cell. The proteins are separated into 5 or 6 fractions and displayed as a curve and corresponding gel pattern. The following imaging tests are a very important part of the diagnosis, staging and management of myeloma: If you're diagnosed with myeloma, you may need to undergo more tests during or after treatment to see how themyeloma cells are responding to therapy. 95:2126-33. This sample is often difficult to collect, and suboptimal collection might alter the result. Image courtesy of Rush University. How is an immunofixation test interpreted? What specimens can be used to perform an immunofixation test? Monoclonal protein | definition of monoclonal protein by Medical dictionary This whole (intact) immunoglobulin, made of the four chains, is usually too large to pass through the kidney. Evidence of monoclonal protein is not apparent." Mayo Clinic, Rochester, Minn. Feb. 8, 2019. Quantitative determination of the serum M component to demonstrate that an IgG or IgM monoclonal protein is less than 3.0 g/dL or an IgA monoclonal protein is less than 2.0 g/dL, or that a Bence-Jones protein is less than or equal to 1.0 g in a 24-hour urine specimen. Available from: UW Health [Internet]. LLS funds lifesaving blood cancer research around the world, provides free information and support services, and is the voice for all blood cancer patients seeking access to quality, affordable, coordinated care. During the fixation phase, antiserum containing anti-IgG, anti-IgA, anti-IgM, anti-light chain kappa, or anti-light chain lambda is inoculated with the serum proteins. This allows them to be measured and analyzed individually. Inflammatory Disease/Inflammation; [cited 2019 Dec 18]; [about 3 screens]. Rajhumar SV. Because MGUS is not harmful, it doesn't need to be treated. 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. Serum protein electrophoresis is used to identify patients with multiple myeloma and other serum protein disorders. 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. Monoclonal light chains also called or Bence Jones protein, are seen in the urine of Multiple myeloma cases in 75 % of the patients. https://www.uptodate.com/contents/search. Goldman L, et al., eds. Unattached, free light chains enter the blood and are excreted rapidly in the urine. Affected patients have no M protein in their urine, no lytic bone lesions, no anemia, no hypercalcemia, and no renal disease. [Full Text]. 1976. Monoclonal gammopathies are conditions in which abnormal proteins are found in the blood. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Therefore, such an approach cannot be currently recommended. Levels of albumin are increased in patients with a relative reduction in serum water (e.g., dehydration). Monoclonal Proteins (M Proteins) | Myeloma Center Characteristic differentiating features of the monoclonal gammopathies are listed in Table 4.7, In some patients with a plasma cell dyscrasia, serum protein electrophoresis may be normal because the complete monoclonal immunoglobulin is absent or is present at a very low level.7 In one series,6 serum protein electrophoresis showed a spike or localized band in only 82 percent of patients with multiple myeloma. Plasma protein levels display reasonably predictable changes in response to acute inflammation, malignancy, trauma, necrosis, infarction, burns, and chemical injury. Available from: Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. Monoclonal gammopathy of undetermined significance (MGUS) - Mayo Clinic The most common condition linked with these abnormal proteins is MGUS. Consequently, urine protein electrophoresis is recommended in all patients suspected of having a plasma cell dyscrasia.10. [Full Text]. Available from: Lab Tests Online [Internet]. [Full Text]. Diagnosis of monoclonal gammopathy of undetermined significance. Characterized by a sharp peak in the beta-gamma region, monoclonal gammopathies involve increased production of immunoglobulins, or antibodies (IgA, IgG, IgM, etc.).