In: Goldman-Cecil Medicine. Serum Immunofixation Test: Purpose, Procedure, and Results - Healthline Immunoglobulins, known as Igs, are a group of proteins that help protect your body from illness. In some cases, the test is done with a urine sample. A monoclonal spike (M spike or paraprotein) on serum protein electrophoresis (SPEP) is a frequent finding in the general population and typically is pathognomonic of an asymptomatic, premalignant condition called monoclonal gammopathy of undetermined significance (MGUS). A negative urine or serum immunofixation result does not always rule out a plasma cell dyscrasia, as a nonsecretory or oligosecretory multiple myeloma can present with a negative immunofixation finding in both the urine and the serum. Affected patients have hyperviscosity and hypercellular bone marrow with extensive infiltration by lymphoplasma cells. The test separates these proteins into subgroups based on their size and electrical charge. Autoinflammatory vs. Autoimmune: What is the Difference? Monoclonal bands are usually seen in the zone but may be seen in proximity of the band or, rarely, in the 2 region. (2015, August 12), Serum protein electrophoresis. Reference Range Immunofixation consists of an electrophoresis phase and a fixation phase. In addition, when protein electrophoresis assays are positive for a monoclonal protein, serum and urine immunofixation are indicated for the appropriate identification of the immunoglobulin and the corresponding light chain. 2015 Oct. 47 (6):564-9. The disorder occurs most commonly in older men. Immunofixation (IFE) Blood Test: MedlinePlus Medical Test IgA or some other type). These measurements indicate the degree to which the myeloma cells in the marrow are affecting normal blood cell development. If there's no disease progression, MGUS doesn't require treatment. High amounts of M protein in a person's blood or urine may be a sign they have multiple myeloma but the presence of M proteins could also indicate other types of plasma cell tumors. Benign monoclonal proteins were first described by Dr. Jan Waldenstrm in 1960 after he detected abnormal narrow hypergammaglobulinemia bands in serum protein electrophoresis (SPEP) samples from healthy individuals. Anemia, pancytopenia, hypercalcemia, and renal disease may be present. If the sample is hemolyzed in vitro (red blood cells are ruptured outside the body such as during traumatic blood draw), there will be free hemoglobin, which migrates to the 1 fraction. Clinical course and management of monoclonal gammopathy of undetermined significance. A polyclonal gammopathy is characterized by a broad diffuse band with one or more heavy chains and kappa and lambda light chains.7, Once a monoclonal gammopathy is identified by serum protein electrophoresis, multiple myeloma must be differentiated from other causes of this type of gammopathy. Monoclonal protein (M protein) levels can be measured in blood and/or urine samples,and these levels generally correlate with the extent of the myeloma. Immunoglobulins are secreted by plasma cells, a type of white blood cell in the bone marrow, in response to infection and disease. AskMayoExpert. [9], Surveillance among patients with MGUS or smoldering (asymptomatic) multiple myeloma, Immunofixation of the urine and serum should be included in a battery of tests after 2-3 months following diagnosis of smoldering myeloma, then every 4-6 months for 1 year, and, finally, every 6-12 months if the results are stable. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process, and they usually are associated with nonmalignant conditions. The albumin band represents the largest protein component of human serum. MGUS usually causes no problems. There are two main types of proteins in the blood: albumin and globulin. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: multiple myeloma; [cited 2019 Dec 10]; [about 3 screens]. Advertising revenue supports our not-for-profit mission. Bone Marrow Tests. The alpha2 component is increased as an acute-phase reactant. Albumin, the major protein component of serum, is produced by the liver under normal physiologic conditions. Ceruloplasmin, alpha2-macroglobulin, and haptoglobin contribute to the alpha2-protein band. Ramakrishnan N, Jialal I. Bence-Jones Protein. Protein Electrophoresis and Isotype, Serum - Mayo Clinic Laboratories There is less than 10 percent plasma cell involvement on bone marrow biopsy. Often, there are associated decreases in the albumin and transferrin levels.6 Table 26 lists characteristic patterns of acute-reaction proteins found on serum protein electrophoresis, along with associated conditions or disorders. 2010. Yang G, Geng C, Chen W. Clinical characteristics of a group of patients with multiple myeloma who had two different light chains by immunofixation electrophoresis: A retrospective study from a single center. Morrow ES Jr. Allscripts EPSi. Typically, the monoclonal protein is discovered, and workup then ensues. 2015 Aug 26. Some immunoglobulins can be abnormal and may be due to cancer. Bone marrow testing involves two steps usually done at the same time in a doctor's office or a hospital: The diagnosis of myeloma depends on three main findings: Revised International Myeloma Working Group (IMWG) Criteria for the Diagnosis of Multiple Myeloma. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. The protein electrophoresis test is often used to find abnormal substances called M proteins. There are a number of reasons why a doctor may order this test. The output of monoclonal protein can vary from patient to patient. 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. [Internet]. Philadelphia, PA, USA: Elsevier Churchill Livingstone; 2008. chapter 87. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant, including multiple myeloma, Waldenstrms macroglobulinemia, solitary plasmacytoma, smoldering multiple myeloma, monoclonal gammopathy of undetermined significance, plasma cell leukemia, heavy chain disease, and amyloidosis. Making sense of serum protein bands - Best Tests July 2011 - bpac Arch Pathol Lab Med. NGS can identify mutations present in the genes of the myeloma cells. Its a useful skill to maintain, as technologists especially those on off-shifts or at smaller sites may still collect through their career(s). To confirm the former and because of the latter, if there is a high index of clinical suspicion, immunofixation studies are required. Sometimes a CBC with differential (CBC with diff), a test that also measures the number of the different types of white blood cells present in the blood, is ordered. M-Spike - Lab Results explained | HealthMatters.io Clin Chem. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. Accessed April 18, 2019. All of these measurements provide information about the extent of the disease and are useful for monitoring response to treatment. 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. Diagnosis is often done with a lab test called electrophoresis. What is the reference range of an immunofixation test? 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). 109:585-8. In some patients, the myeloma cells do not make a complete monoclonal immunoglobulin molecule with two heavy and two light chains. If the curve is relatively normal (e.g. 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. Mass spectrometry for the evaluation of monoclonal proteins in multiple myeloma and related disorders: an International Myeloma Working Group Mass Spectrometry Committee Report. The names of these subsets are based on the method that is used to separate and differentiate the various serum components. Available from: Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. These conditions should be promptly diagnosed and treated. Multiple Myeloma. The net charge (positive or negative) and the size and shape of the protein commonly are used in differentiating various serum proteins.1. Under the PE Value it says: "SPE1". A monoclonal protein is produced by the abnormal, cancerous or precancerous cells. Genetic changes and environmental triggers appear to play a role. Please login or register first to view this content. Learn more about laboratory tests, reference ranges, and understanding results. We want you to take advantage of everything Cancer Therapy Advisor has to offer. 2019 May 23. Immunofixationconsists of an electrophoresis phase and a fixation phase. In addition to SPEP followed by immunofixation, quantitative serum immunoglobulin should be performed, because the M component must be greater than3 g/dL in the serum. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Peripheral blood smear often shows RBCs in a stacked or rouleaux formation. Accessed April 18, 2019. The patient urinates each time into a clean dry vessel and then pours the urine in the plastic container, which is kept at a cold temperature (eg, in the refrigerator). If the monoclonal protein level decreases or is undetectable after chemotherapy, it might indicate a response to treatment. On the contrary, a persistent monoclonal protein despite treatment is a sign of refractory disease. Keywords: bone marrow; monoclonal protein; multiple myeloma; protein electrophoresis; serum free light chains. Our website services, content, and products are for informational purposes only. IgA or IgM bands are less common. (2015, August 21). 2018 Sep 7. [Full Text]. Immunofixation reveals the heavy chain as alpha, gamma, or mu. Low concentration of monoclonal immunoglobulins (LCMI) Heavy chain disease Suggested Additional Lab Testing For multiple myeloma: In addition to SPEP followed by immunofixation, quantitative. Evidence of end-organ damage as defined by the CRAB criteria. CSF immunofixation that does not reveal oligoclonal bands is also considered normal. This causes the different types of proteins to move and group together. Protein Electrophoresis questions. Protein Electrophoresis, Immunofixation Electrophoresis; [updated 2019 Oct 25; cited 2019 Dec 10]; [about 2 screens]. Rochester (NY): University of Rochester Medical Center; c2019. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, for Monoclonal gammopathy of undetermined significance (MGUS), Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Monoclonal gammopathy of undetermined significance (MGUS), Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Essential Thrombocythemia: Looking for information and support. Serum is placed on a specific medium, and a charge is applied. Malnutrition, significant liver disease, renal loss (e.g., in nephrotic syndrome), hormone therapy, and pregnancy may account for a low albumin level. M-Protein Antibodies and Significance in Blood - Verywell Health Immunoglobulins are proteins that function as antibodies, which fight infection. 1976. Monoclonal Protein on Serum Protein Electrophoresis (M Component) Urine protein electrophoresis (UPEP) is, C-reactive protein is produced by the liver in response to inflammation. Kaplan JS, Horowitz GL. All rights reserved. The test may also be performed again in the future. Blood. Moving toward the negative portion of the gel (i.e., the negative electrode), the next peaks involve the alpha1 and alpha2 components. Follow-up of multiple myeloma, Waldenstrom macroglobulinemia, and AL amyloidosis, Immunofixation of urine and serum samples should be performed in all patients with multiple myeloma, Waldenstrom macroglobulinemia, and AL amyloidosis every 3 months after the completion of treatment in order to evaluate for response or to document a relapse. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. [10], Primary screening for plasma cell dyscrasias, No studies have addressed the role of serum or urine immunofixation in screening of the general population for multiple myeloma and related disorders. Flow Cytometry. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjA4Njk3Ni1vdmVydmlldw==. These so-called monoclonal gammopathies constitute a group of disorders that are characterized by proliferation of a single clone of plasma cells that produce a homogeneous M protein.6, It is extremely important to differentiate monoclonal from polyclonal gammopathies. The peaks for these components lie toward the negative electrode, with the gamma peak being closest to that electrode. Monoclonal gammopathy of undetermined significance (MGUS). Protein electrophoresis alone is not considered an adequate screen for monoclonal gammopathies. A homogeneous immunoglobulin resulting from the proliferation of a single clone of plasma cells that; during electrophoresis of serum, appears as a narrow band or "spike"; it is characterized by heavy chains of a single class and subclass, and light chains of a single type. A second screen is used to confirm positive test results. Each plasma cell produces one of five types of antibodies: IgG, IgA, IgM, IgE or IgD, and either kappa or lambda. Cancer.Net [Internet]. Consequently, urine protein electrophoresis is recommended in all patients suspected of having a plasma cell dyscrasia.10. [12] an additional assay for the identification of IgD or IgE must be performed. Blood. URL of this page: https://medlineplus.gov/lab-tests/immunofixation-ife-blood-test/. Although this spike is usually greater than 3 g per dL in patients with multiple myeloma, up to one fifth of patients with this tumor may have an M-protein spike of less than 1 g per dL.10 Hypogammaglobulinemia on serum protein electrophoresis occurs in about 10 percent of patients with multiple myeloma who do not have a serum M-protein spike.11 Most of these patients have a large amount of Bence Jones protein (monoclonal free kappa or lambda chain) in their urine.11 Thus, the size of the M-protein spike is not helpful in excluding multiple myeloma.