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Evaluation and characterization of monoclonal gammopathies using serum protein electrophoresis in a major urban population: one institution’s experience
  1. Derek B Laskar1,
  2. Khurram Shafique1,
  3. Chuanyong Lu2,
  4. Alejandro Zuretti1
  1. 1Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York, USA
  2. 2Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
  1. Correspondence to Dr Derek B Laskar, Department of Pathology, State of New York Downstate Medical Center, 450 Clarkson Avenue, MSC 25, Brooklyn, NY 11203, USA; Derek.Laskar{at}downstate.edu

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Introduction

Serum protein electrophoresis (SPEP) with serum protein immunofixation electrophoresis (SPIFE) are clinical laboratory techniques used to identify, evaluate and monitor a wide range of disease states where abnormal serum protein levels are observed.1 Such disorders include solid tumors, lymphoproliferative disorders (eg, multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS), Waldenström macroglobulinemia, primary amyloidosis, chronic lymphocytic leukemia, lymphoma), acute and chronic infections, trauma, connective tissue diseases, and liver disorders.2 Clinical indications for ordering SPEPs are varied: suspected lymphoproliferative disorders; unexplained back pain, anemia, weakness or fatigue; osteolytic lesions; unexplained renal insufficiency; hypercalcemia; unexplained peripheral neuropathy; elevated erythrocyte sedimentation rate; and recurrent infections.2

Changes observed in SPEPs follow predictable patterns guiding clinicians toward correct interpretation and diagnosis. Polyclonal gammaglobulin protein elevation typically results from reactive, inflammatory or infectious processes. Monoclonal gammaglobulin protein elevation (monoclonal gammopathy; MG) is typified by a sharp band or monoclonal spike (M-component) confined to the gammaglobulin region of the electrophoretogram; however, MG proteins can also be observed within α-1, α-2 and β-globulin regions.1 2 These monoclonal bands result from a single abnormal plasma cell or B lymphocyte clone, which could be from a malignant (MM, Waldenström macroglobulinemia) or premalignant process (MGUS).1 2 Initial SPEP evaluation is typically performed in conjunction with SPIFE to identify and confirm monoclonality, and determine the …

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