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Lim SM, Wijeratne N, Choy KW, Nguyen TTH, Setiawan L, Loh TP. A review of clinical guidelines, laboratory recommendations and external quality assurance programs for monoclonal gammopathy testing. Crit Rev Clin Lab Sci 2024; 61:107-126. [PMID: 37776896 DOI: 10.1080/10408363.2023.2257306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/06/2023] [Indexed: 10/02/2023]
Abstract
Monoclonal gammopathy (MG) is a spectrum of diseases ranging from the benign asymptomatic monoclonal gammopathy of undetermined significance to the malignant multiple myeloma. Clinical guidelines and laboratory recommendations have been developed to inform best practices in the diagnosis, monitoring, and management of MG. In this review, the pathophysiology, relevant laboratory testing recommended in clinical practice guidelines and laboratory recommendations related to MG testing and reporting are examined. The clinical guidelines recommend serum protein electrophoresis, serum immunofixation and serum free light chain measurement as initial screening. The laboratory recommendations omit serum immunofixation as it offers limited additional diagnostic value. The laboratory recommendations offer guidance on reporting findings beyond monoclonal protein, which was not required by the clinical guidelines. The clinical guidelines suggested monitoring total IgA concentration by turbidimetry or nephelometry method if the monoclonal protein migrates in the non-gamma region, whereas the laboratory recommendations make allowance for involved IgM and IgG. Additionally, several external quality assurance programs for MG protein electrophoresis and free light chain testing are also appraised. The external quality assurance programs show varied assessment criteria for protein electrophoresis reporting and unit of measurement. There is also significant disparity in reported monoclonal protein concentrations with wide inter-method analytical variation noted for both monoclonal protein quantification and serum free light chain measurement, however this variation appears smaller when the same method was used. Greater harmonization among laboratory recommendations and reporting format may improve clinical interpretation of MG testing.
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Affiliation(s)
| | - Nilika Wijeratne
- Dorevitch Pathology, Melbourne, Australia
- School of Clinical Sciences at Monash Health, Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- Eastern Health Pathology, Eastern Health, Box Hill, Australia
- Dorevitch Pathology, Heidelberg, Australia
| | | | | | - Lyana Setiawan
- Dharmais Hospital National Cancer Centre, West Jakarta, Indonesia
| | - Tze Ping Loh
- National University Hospital, Singapore, Singapore
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Chong YP, Lim SM, Loh TP, Mollee P, Wijeratne N, Choy KW. Screening for and diagnosis of monoclonal gammopathy. J Clin Pathol 2023; 76:727-733. [PMID: 37604683 DOI: 10.1136/jcp-2023-208774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
Monoclonal gammopathy is a spectrum of disorders characterised by clonal proliferation of plasma cells or lymphocytes, which produce abnormal immunoglobulin or its components (monoclonal proteins). Monoclonal gammopathies are often categorised as low-tumour-burden diseases (eg, amyloid light chain (AL) amyloidosis), premalignant disorders (such as monoclonal gammopathy of undetermined significance and smouldering multiple myeloma), and malignancies (eg, multiple myeloma and Waldenström's macroglobulinaemia). Such diversity of concentration and structure makes monoclonal protein a challenging clonal marker. This article provides an overview on initial laboratory testing of monoclonal gammopathy to guide clinicians and laboratory professionals in the selection and interpretation of appropriate investigations.
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Affiliation(s)
- Yuh Ping Chong
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Say Min Lim
- Department of Pathology, Hospital Teluk Intan, Teluk Intan, Malaysia
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Peter Mollee
- Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nilika Wijeratne
- Dorevitch Pathology, Heidelberg, Victoria, Australia
- School of Clinical Sciences at Monash Health, Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Eastern Health Pathology, Eastern Health, Box Hill, Victoria, Australia
| | - Kay Weng Choy
- Department of Pathology, Northern Health, Epping, Victoria, Australia
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Şeneş M, Alpdemir M, Kırtıl G, Öğüş E, Çolak Samsum E, Alpdemir MF. Effects of lipemia on capillary serum protein electrophoresis in native ultra-lipemic material and intravenous lipid emulsion added sera. Clin Chem Lab Med 2022; 61:1054-1064. [PMID: 36583398 DOI: 10.1515/cclm-2022-0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aims to investigate the effect of natural ultralipemic material (NULM) and intravenous lipid emulsion (IVLE) on capillary serum protein electrophoresis (SPEP). METHODS NULM material was prepared from leftover patients' lipemic serum sample (triglyceride concentration >2,000 mg/dL) pool by a refrigerated high-speed centrifuge, and IVLE Omegaven lipid emulsion (30%) was used. Serum pools for interference study were prepared from patient samples for which serum protein electrophoresis was studied as Normal SPEP and M Peak SPEP. For both types of lipemia (DULM and IVLE), five pools with triglyceride concentrations of ∼4.52 mmol/L, ∼7.91 mmol/L, ∼14.69 mmol/L, ∼21.47 mmol/L, and ∼28.25 mmol/L were prepared. SPEP was studied in each pool with Sebia Capillarys Minicap. A repeated measure ANOVA test was used to determine the difference between the pools, and interferograms were used to evaluate the interference effect. RESULTS Interference was not detected in IVLE added Normal SPEP and M Peak SPEP pools, either % or concentrations of fractions. In NULM-added Normal SPEP and M Peak SPEP pools, significant positive interference in albumin % (p=0.002 and p<0.001 respectively) and significant negative interference in gamma% (p<0.001 and p=0.005 respectively) and M protein peak (p=0.002) fractions were detected. However, significant positive interference was seen only for albumin concentration fractions (p<0.001 for both pools). CONCLUSIONS It is vital to use NULM instead of IVLE solutions in lipemia interference studies for all laboratory tests, including CZE SPEP. The fractions concentration values calculated with the total protein concentration should be used for evaluating SPEP results.
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Affiliation(s)
- Mehmet Şeneş
- Medical Biochemistry, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
| | - Medine Alpdemir
- Medical Biochemistry, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
| | - Gül Kırtıl
- Medical Biochemistry, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
| | - Elmas Öğüş
- Medical Biochemistry, University of Health Sciences Ankara Training and Research Hospital, Ankara, Türkiye
| | - Emel Çolak Samsum
- Medical Biochemistry, Ministry of Health Pursaklar State Hospital, Ankara, Türkiye
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Šegulja D, Matišić D, Barišić K, Rogić D. A novel approach for more precise quantification of M-protein using variables derived from immunosubtraction electropherogram and associated biochemistry analytes. Biochem Med (Zagreb) 2022; 32:030701. [PMID: 35966255 PMCID: PMC9344871 DOI: 10.11613/bm.2022.030703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Due to limitations in currently used methodologies, the widely acknowledged approach for quantifying M-protein (MP) is not available. If employed as a source of quantitative data, the immunosubtraction electropherogram (IS-EPG), a qualitative analysis of MP, has the potential to overcome known analytical issues. The aim of this study is to explore measured and derived variables obtained from immunosubtraction electropherogram as a tool for quantifying MP and to compare the derived results to currently available methods. Materials and methods Measurands were amplitudes of MP and albumin fractions. Assessed derived variables included also immunoglobulin (Ig) G, IgA, IgM and total protein data. Capillary electrophoresis was used for determination of MP (in % of total protein concentration, or concentration of MP in g/L) by perpendicular drop and tangent skimming method. Results Passing-Bablok analysis showed the most comparable results in D1Ig and D1nIg variables, and the largest discrepancies in AD1nIg and AD2nIg variables. The background presence had greater impact on D1nIg comparison results than did on D1Ig results. The contribution of albumin fraction data did not improve the comparability of the results. The coefficients of variation of derived variables were lower (maximum 3.1%) than those obtained by densitometric measurements, regardless of MP concentration, polyclonal background, or migration pattern (2.3-37.7%). Conclusion The amplitude of MP spike in IS-EPG is an valuable measurand to compute derived variables for quantifying MP. The most comparable results were achieved with the D1Ig variable. Patients with monoclonal gammopathy can benefit from increased precision employing an objective and background independent measurand, especially during longitudinal follow-up.
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Affiliation(s)
- Dragana Šegulja
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
- Corresponding author:
| | | | - Karmela Barišić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
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Keren DF, Bocsi G, Billman BL, Etzell J, Faix JD, Kumar S, Lipe B, McCudden C, Montgomery R, Murray DL, Rai AJ, Redondo TC, Souter L, Ventura CB, Ansari MQ. Laboratory Detection and Initial Diagnosis of Monoclonal Gammopathies. Arch Pathol Lab Med 2022; 146:575-590. [PMID: 34347866 DOI: 10.5858/arpa.2020-0794-cp] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The process for identifying patients with monoclonal gammopathies is complex. Initial detection of a monoclonal immunoglobulin protein (M protein) in the serum or urine often requires compilation of analytical data from several areas of the laboratory. The detection of M proteins depends on adequacy of the sample provided, available clinical information, and the laboratory tests used. OBJECTIVE.— To develop an evidence-based guideline for the initial laboratory detection of M proteins. DESIGN.— To develop evidence-based recommendations, the College of American Pathologists convened a panel of experts in the diagnosis and treatment of monoclonal gammopathies and the laboratory procedures used for the initial detection of M proteins. The panel conducted a systematic literature review to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, recommendations were created based on the available evidence, strength of that evidence, and key judgements as defined in the Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision framework. RESULTS.— Nine guideline statements were established to optimize sample selection and testing for the initial detection and quantitative measurement of M proteins used to diagnose monoclonal gammopathies. CONCLUSIONS.— This guideline was constructed to harmonize and strengthen the initial detection of an M protein in patients displaying symptoms or laboratory features of a monoclonal gammopathy. It endorses more comprehensive initial testing when there is suspicion of amyloid light chain amyloidosis or neuropathies, such as POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome, associated with an M protein.
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Affiliation(s)
- David F Keren
- From the Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor (Keren).,Keren and Ansari served as guideline cochairs
| | - Gregary Bocsi
- The Department of Pathology, University of Colorado Anschutz, Aurora (Bocsi)
| | - Brooke L Billman
- Governance Services (Billman), College of American Pathologists, Northfield, Illinois
| | - Joan Etzell
- The Department of Pathology, Sutter Health Shared Laboratory, Livermore, California (Etzell)
| | - James D Faix
- tHe Department of Pathology, Montefiore Medical Center, Bronx, New York (Faix)
| | - Shaji Kumar
- The Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (Kumar)
| | - Brea Lipe
- The Department of Medicine, University of Rochester Medical Center, Rochester, New York (Lipe)
| | - Christopher McCudden
- The Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (McCudden)
| | | | - David L Murray
- The Department of Pathology, PeaceHealth Southwest Medical Center, Vancouver, Washington (Murray)
| | - Alex J Rai
- The Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York (Rai)
| | | | - Lesley Souter
- Methodology Consultant, Hamilton, Ontario, Canada (Souter)
| | | | - Mohammad Qasim Ansari
- and the Department of Pathology and Laboratory Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio (Ansari).,Keren and Ansari served as guideline cochairs
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Šegulja D, Šparakl T, Rogić D. Applied capillary electrophoresis system affects screening for monoclonal gammopathy in serum: verification study of two eight-capillary systems. Scandinavian Journal of Clinical and Laboratory Investigation 2022; 82:85-89. [PMID: 35112636 DOI: 10.1080/00365513.2022.2034035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Capillary electrophoresis is a method with a long history of developments which enables monitoring of several pathological processes and has an irreplaceable role in screening for presence of M-protein. The aim of this study was to assess analytical performance of Sebia and Helena systems, as well as their screening efficiency for M-protein by identifying characteristic electrophoretic pattern abnormalities. The controls were analyzed in triplicate over a five-day period. Comparability testing was performed on 46 (Capillarys3Octa) and 49 (V8Nexus) serum samples with routinely used Capillarys2. Electropherograms (EPGs) were reviewed by two specialists independently to select samples for further processing by immunofixation. All precision test results met the eligibility criteria by Ricos et al. The correlation coefficients higher than 0.8 indicated excellent comparability although the results were slightly more comparable among the same manufacturer systems. There were no variations in observed abnormalities in EPGs when Capillarys systems were compared, but a disparity was detected in 11/49 EPGs on comparing Capillarys2 and V8Nexus. The cause of the detected difference could be in a different graphical presentation of the findings and in a lesser resolution of the applied buffer. The impression is that the V8Nexus system combined with the utilized buffer provides greater resolution in the alpha-1 and alpha-2 globulin fractions, but that it declines in the gamma globulin fraction. The precision and estimated accuracy criteria were met by both systems. Comparison results implied that capillary systems are not equally effective in M-protein screening, highlighting the necessity to include system screening efficiency in analytical evaluation.
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Affiliation(s)
- Dragana Šegulja
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tajana Šparakl
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
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Mrosewski I, Urbank M. Identification of Paraproteins via Serum Immunofixation or Serum Immunosubtraction and Immunoturbidimetric Quantitation of Serum Immunoglobulins in the Laboratory Testing for Monoclonal Gammopathies. Arch Pathol Lab Med 2021; 145:1552-1557. [DOI: 10.5858/arpa.2020-0441-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/06/2022]
Abstract
Context.—
In laboratory testing for monoclonal gammopathies, paraproteins are identified via serum immunofixation or serum immunosubtraction, and immunoturbidimetric quantitation of serum immunoglobulins is often used.
Objective.—
To evaluate methodologic differences between serum immunofixation and serum immunosubtraction, as well as in the quantitation of serum immunoglobulins on different clinical chemical platforms.
Design.—
Three hundred twenty-two unique routine patient samples were blinded and used for comparison between serum immunofixation on Sebia's HYDRASIS 2 and serum immunosubtraction on Sebia's CAPILLARYS 2, as well as between quantitation results of immunoglobulin A, G, and M on Abbott's ARCHITECT c16000PLUS and Roche's Cobas c 502 module. Microsoft Excel 2019 with the add-on Abacus 2.0 and MedCalc were used for statistical analysis and graphic depiction via bubble diagram, Passing-Bablok regressions, and Bland-Altman plots.
Results.—
The median age of patients was 75 years, and samples with paraproteinemia were nearly evenly split between sexes. Paraprotein identification differed remarkably between immunofixation and immunosubtraction. Quantitation of serum immunoglobulins showed higher values on Abbott's ARCHITECT c16000PLUS when compared with Roche's Cobas c 502 module.
Conclusions.—
Identification of paraproteins via serum immunosubtraction is inferior to serum immunofixation, which can have implications on the diagnosis and monitoring of patients with monoclonal gammopathy. If immunoturbidimetric quantitation of immunoglobulins is used for follow-up, the same clinical-chemical platform should be used consistently.
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Affiliation(s)
- Ingo Mrosewski
- From the Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Matthias Urbank
- From the Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
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8
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Thoren KL, McCash SI, Murata K. Immunotyping Provides Equivalent Results to Immunofixation in a Population with a High Prevalence of Monoclonal Gammopathies. J Appl Lab Med 2021; 6:1551-1560. [PMID: 34329441 DOI: 10.1093/jalm/jfab067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Serum immunofixation (IF) is a common laboratory test used to diagnose and monitor patients with monoclonal gammopathies. Similarly, immunotyping (IT) by capillary electrophoresis can confirm the presence of a monoclonal protein (M-protein) and determine its isotype. The goal of this study was to compare the ability of IT and IF to detect M-proteins. METHODS IT and IF results for 1000 waste clinical serum samples were obtained. All results were interpreted blindly by reviewers who were experienced in each technique. Results were compared by band. Results were also compared to patient history to determine if the original clone was present. We determined the sensitivity of IT and IF alone and in combination with additional tests. Finally, we evaluated the impact of reviewer training on the sensitivity of IT. RESULTS IT and IF were concordant in 721/773 (93%) samples with a history of an intact M-protein and in 143/172 (83%) samples with a history of a free light chain (FLC) M-protein. IF was significantly more sensitive than IT for the detection of FLC M-proteins (P < 0.0001). However, IF was not more sensitive than IT for detection of intact M-proteins (P = 0.1272) or when each test was combined with the FLC ratio or urine immunofixation (P = 0.2812 and P = 0.6171, respectively). Finally, after training, inexperienced reviewers improved their IT sensitivity by 19%. CONCLUSION IT provides equivalent results to IF for the detection of monoclonal proteins. Training and experience are critical to the accurate interpretation of IT.
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Affiliation(s)
- Katie L Thoren
- Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel I McCash
- Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kazunori Murata
- Clinical Chemistry Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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9
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Eeckhout K, Van Cotthem K, Van Hoof V, Guerti K. A Persistent Additional Fraction on Capillary Zone Electrophoresis with Negative Immunofixation Electrophoresis: Paraproteinemia or Pseudoparaproteinemia? J Appl Lab Med 2021; 6:790-794. [PMID: 32984878 DOI: 10.1093/jalm/jfaa085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Katrien Eeckhout
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium
| | - Karin Van Cotthem
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium
| | - Viviane Van Hoof
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium
| | - Khadija Guerti
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium
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Gastélum-Cano JM, Fragoso-Flores J, Noffal-Nuño VM, Deffis-Court M. An unusual pattern in serum protein electrophoresis to take in mind: A case report. Pract Lab Med 2021; 24:e00200. [PMID: 33490350 PMCID: PMC7810760 DOI: 10.1016/j.plabm.2020.e00200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 12/28/2020] [Indexed: 01/21/2023] Open
Abstract
Here we described a case of an asymptomatic 73 years-old female patient in geriatric routine consultation, whose laboratory testing showed hyperproteinemia with accompanying hyperglobulinemia. A diagnosis of BGUS was made only after a correlation among SPEP, densitometry tracing and IFE results was established, evidencing a second peak, that was less evident and not reported at first. These biclonal conditions are of very low incidence in the clinical laboratory, requiring the laboratory professional to have particular skills for their identification. As far as is known, clinical findings in BGUS are similar to those found in MGUS. However, they remain not well understood. Therefore, for an accurate diagnosis of BGUS, the clinical laboratory technician must be trained and sensitized to detect a second M - protein as a band or peak; taking in mind the possible different scenarios in heavy and light chain typing.
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Affiliation(s)
- José María Gastélum-Cano
- Laboratorios Ruiz, Mártires Del 2 de Octubre 808, Anzures, 72530, Puebla, Mexico
- Universidad Popular Autónoma Del Estado de Puebla, 21 Sur 1103, Barrio Santiago, 72410, Puebla, Mexico
| | - Jaime Fragoso-Flores
- Laboratorios Ruiz, Mártires Del 2 de Octubre 808, Anzures, 72530, Puebla, Mexico
- Universidad Popular Autónoma Del Estado de Puebla, 21 Sur 1103, Barrio Santiago, 72410, Puebla, Mexico
| | | | - Marcela Deffis-Court
- Hospital Médica Sur, Puente de Piedra 150, Toriello Guerra, 14050, Ciudad de México, Mexico
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11
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Immunofixation Electrophoresis for Identification of Proteins and Specific Antibodies. Methods Mol Biol 2018. [PMID: 30426418 DOI: 10.1007/978-1-4939-8793-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Immunofixation electrophoresis (IFE) is a technique for the identification of proteins within complex mixtures after separation by either conventional zone electrophoresis or isoelectric focusing. Most commonly antigens (which are often immunoglobulins) are separated by electrophoresis followed by precipitation with specific antibodies in situ. However, immunoglobulins with specific reactivity can be also precipitated with the proper antigens after electrophoresis in reverse or reversed IFE. Because of its great versatility, potentially high sensitivity, ease to perform and customize, and relatively low cost with no requirement for expensive instrumentation, manual IFE remains a valuable tool for both clinical diagnostic testing and research. Any low-viscosity body fluid specimen or, possibly, culture fluid could be tested with IFE if proper antibodies (or antigens in reverse[d] IFE) are available. After pretreatment with chaotropic and/or reducing agents, even high-viscosity specimens might be amenable to testing with IFE.
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12
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Rodić P, Lakočević M, Pavlović S, Đurašević TK, Kostić T, Vuković NS, Šumarac Z, Petakov M, Janić D. Immunoglobulin Heavy Chain Gene Rearrangements in Patients with Gaucher Disease. J Med Biochem 2018; 37:307-312. [PMID: 30598627 PMCID: PMC6298462 DOI: 10.1515/jomb-2017-0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several studies support the evidence of increased incidence of hematological complications in Gaucher disease including monoclonal and polyclonal gammopathies and blood malignancies, especially multiple myeloma. METHODS Serum concentrations of immunoglobulins and PCR analysis of the IGH gene rearrangements were performed. The clonal PCR products were directly sequenced and analyzed with the appropriate database and tools. Serum monoclonal proteins were detected and identified by electrophoresis. RESULTS Among 27 Gaucher patients, clonal IGH rearrangement was discovered in eight, with 5/8 having also serum monoclonal protein. Elevated immunoglobulins were detected in 9/27 patients. Follow-up data for 17 patients showed that the clonal rearrangement remained the same in four of them, however, in one patient it disappeared after the follow-up period. The remaining 12/17 patients were without previous IGH clonal rearrangement and remained so after the follow-up. CONCLUSIONS Although clonal expansion may occur relatively early in the disease course, at least judging by the IGH gene rearrangements in Gaucher patients, the detected clones may be transient. A careful clinical follow-up in these patients is mandatory, including monitoring for lymphoid neoplasms, especially multiple myeloma.
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Affiliation(s)
- Predrag Rodić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Hematology and Oncology, University Children's Hospital, Belgrade, Serbia
| | - Milan Lakočević
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Sonja Pavlović
- Institute of Molecular Genetics and Genetic Engineering (IMGGE), University of Belgrade, Belgrade, Serbia
| | - Teodora Karan Đurašević
- Institute of Molecular Genetics and Genetic Engineering (IMGGE), University of Belgrade, Belgrade, Serbia
| | - Tatjana Kostić
- Institute of Molecular Genetics and Genetic Engineering (IMGGE), University of Belgrade, Belgrade, Serbia
| | - Nada Suvajdžić Vuković
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Hematology, Clinical Center of SerbiaBelgrade, Serbia
| | - Zorica Šumarac
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Petakov
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Dragana Janić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Hematology and Oncology, University Children's Hospital, Belgrade, Serbia
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Miyazaki K, Suzuki K. Abnormal Heavy/Light Chain Ratio and Matched Pair Suppression Increase Residual Disease Detection Sensitivity in Patients With Multiple Myeloma With Deep Responses. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:293-296. [DOI: 10.1016/j.clml.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
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Booth RA, McCudden CR, Balion CM, Blasutig IM, Bouhtiauy I, Rodriguez-Capote K, Catomeris P, Chan PC, Chen Y, Collier C, Hauff K, Kalra J, Li D, Lin DC, Lou AH, Meng QH, Morrison T, Pasic MD, Qureshi M, Randell E, Sohn KY, Thakur V, Thomas D, Thoni A, Tomalty C, Yang L, Zamkanei M. Candidate recommendations for protein electrophoresis reporting from the Canadian Society of Clinical Chemists Monoclonal Gammopathy Working Group. Clin Biochem 2018; 51:10-20. [DOI: 10.1016/j.clinbiochem.2017.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/26/2022]
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Regeniter A, Siede W. Peaks and tails: Evaluation of irregularities in capillary serum protein electrophoresis. Clin Biochem 2018; 51:48-55. [DOI: 10.1016/j.clinbiochem.2017.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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16
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Genzen JR, Murray DL, Abel G, Meng QH, Baltaro RJ, Rhoads DD, Delgado JC, Souers RJ, Bashleben C, Keren DF, Ansari MQ. Screening and Diagnosis of Monoclonal Gammopathies: An International Survey of Laboratory Practice. Arch Pathol Lab Med 2017; 142:507-515. [DOI: 10.5858/arpa.2017-0128-cp] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Serum tests used for the screening and diagnosis of monoclonal gammopathies include serum protein electrophoresis (SPE; agarose gel or capillary zone), immunofixation (IFE) and immunosubtraction capillary electrophoresis, serum free light chains, quantitative immunoglobulins, and heavy/light–chain combinations. Urine protein electrophoresis and urine IFE may also be used to identify Bence-Jones proteinuria.
Objective.—
To assess current laboratory practice for monoclonal gammopathy testing.
Design.—
In April 2016, a voluntary questionnaire was distributed to 923 laboratories participating in a protein electrophoresis proficiency testing survey.
Results.—
Seven hundred seventy-four laboratories from 38 countries and regions completed the questionnaire (83.9% response rate; 774 of 923). The majority of participants (68.6%; 520 of 758) used agarose gel electrophoresis as their SPE method, whereas 31.4% (238 of 758) used capillary zone electrophoresis. The most common test approaches used in screening were SPE with reflex to IFE/immunosubtraction capillary electrophoresis (39.3%; 299 of 760); SPE only (19.1%; 145 of 760); SPE and IFE or immunosubtraction capillary electrophoresis (13.9%; 106 of 760); and SPE with IFE, serum free light chain, and quantitative immunoglobulins (11.8%; 90 of 760). Only 39.8% (305 of 767) of laboratories offered panel testing for ordering convenience. Although SPE was used by most laboratories in diagnosing new cases of myeloma, when laboratories reported the primary test used to follow patients with monoclonal gammopathy, only 55.7% (403 of 724) chose SPE, with the next most common selections being IFE (18.9%; 137 of 724), serum free light chain (11.7%; 85 of 724), and immunosubtraction capillary electrophoresis (2.1%; 15 of 724).
Conclusions.—
Ordering and testing practices for the screening and diagnosis of monoclonal gammopathy vary widely across laboratories. Improving utilization management and report content, as well as recognition and development of laboratory-directed testing guidelines, may serve to enhance the clinical value of testing.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mohammad Q. Ansari
- From the Department of Pathology, University of Utah, Salt Lake City, and ARUP Laboratories, Salt Lake City, Utah (Drs Genzen and Delgado); the Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota (Dr Murray); the Department of Laboratory Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts (Dr Abel); the Department of Laboratory Medicine, University of Texas MD An
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Monari M, Bianchi P, Maura F, Motta L, Martellasio G, Leone FP, Montanelli A. Typing of Four Cases of Monoclonal Gammopathy: A Revival of Immunosubstraction Role. Health (London) 2017. [DOI: 10.4236/health.2017.913134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Miyazaki K, Suzuki K. Capillary electrophoresis/immunosubtraction as a better alternative to immunofixation for detecting and immunotyping serum monoclonal proteins in patients with immunoglobulin light chain (AL) amyloidosis. Amyloid 2016; 23:221-224. [PMID: 27682970 DOI: 10.1080/13506129.2016.1232647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Capillary electrophoresis/immunosubtraction (CE/IS) is a simple method for detecting and immunotyping serum or urine monoclonal proteins. To our knowledge, there are no previous reports of the use of CE/IS for characterizing patients with Immunoglobulin light chain (AL) amyloidosis, and there are no convincing data available to compare CE/IS with serum immunofixation electrophoresis (IFE) and free light chain (FLC) assay. The aim of this study was to evaluate the clinical utility of CE/IS in patients with AL amyloidosis as a diagnostic accuracy study. This study included 50 patients with AL amyloidosis (17 newly diagnosed and 33 undergoing treatment). Serum IFE identified monoclonal proteins in 15/50 (30%) of all cases and in 7/17 (41%) of newly diagnosed cases. CE/IS identified monoclonal proteins in 16/50 (32%) of all cases and in 7/17 (41%) of newly diagnosed cases. The FLC assay detected an abnormal ratio of kappa and lambda light chains in 26/50 (52%) of all cases and in 15/17 (88%) of newly diagnosed cases. IFE and CE/IS combined with FLC assay identified monoclonal proteins more sensitive than IFE alone and CE/IS alone, in newly diagnosed patients (p = 0.002 and 0.002, respectively) and in patients undergoing treatment (p = 0.031 and 0.016, respectively). CE/IS is an acceptable alternative to IFE.
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Affiliation(s)
- Kanji Miyazaki
- a Department of Hematology , Japanese Red Cross Medical Center , Tokyo , Japan
| | - Kenshi Suzuki
- a Department of Hematology , Japanese Red Cross Medical Center , Tokyo , Japan
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19
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Deighan WI, O'Kane MJ, McNicholl FP, Keren DF. Multiple myeloma and multiple plasmacytomas associated with free gamma heavy chain, free kappa light chain and IgGk paraproteins: an unusual triple gammopathy. Ann Clin Biochem 2016; 53:706-711. [PMID: 27166317 DOI: 10.1177/0004563216646594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multiple myeloma is a malignant plasma cell dyscrasia that is becoming more prevalent in an increasingly ageing population. It is a complex disease with clinical phases ranging from the premalignant monoclonal gammopathy of undetermined significance to asymptomatic (smouldering) myeloma and then symptomatic myeloma; the latter occasionally terminating in the clonal proliferation of plasma cells outside the bone marrow. We present a patient whose clonally evolved disease from monoclonal gammopathy of undetermined significance to multiple myeloma demonstrated the presence of an unusual combination of monoclonal immunoproteins. Capillary electrophoresis demonstrated the presence of three paraproteins in the gamma region (γ-region), two of which were additional to the IgGk paraprotein which migrated in the slow γ-region at initial diagnosis. Subsequent isotypic identification of the new paraproteins was not possible by immunotyping and initial immunofixation studies failed to definitively characterize the monoclonal proteins. After reduction with beta-mercaptoethanol, two paraproteins were detected by both capillary and gel electrophoresis. However, only immunofixation was able to resolve three distinct monoclonal bands, confirming the presence of free monoclonal kappa light chains in the mid-gamma region and free monoclonal heavy chains in the fast gamma region. Triple gammopathies in themselves are uncommon; this case presents a very unusual combination of paraproteins which required various electrophoretical and immunochemical techniques to identify and characterize them. The change of electrophoretic signature from the monoclonal gammopathy of undetermined significance phase to the diagnosis of multiple myeloma suggested that a number of genetically distinct subclones were present in the pretreatment clonal evolution of the disease.
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Affiliation(s)
- William I Deighan
- 1 Department of Clinical Chemistry, Altnagelvin Hospital, Londonderry, N. Ireland
| | - Maurice J O'Kane
- 1 Department of Clinical Chemistry, Altnagelvin Hospital, Londonderry, N. Ireland
| | | | - David F Keren
- 3 Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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20
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Chang CC, Su MJ, Lee SJ, Tsai YH, Kuo LY, Lin IH, Huang HL, Yen TH, Chu FY. The Immunotyping Distribution of Serum Monoclonal Paraprotein and Environmental Impact on Multiple Myeloma (MM) and Monoclonal Gammopathy of Uncertain Significance (MGUS) in Taiwan: A Medical Center-Based Experience. Asian Pac J Cancer Prev 2016; 17:395-9. [PMID: 26838245 DOI: 10.7314/apjcp.2016.17.1.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether ambient exposure to environmental pollutants leads to hematopoietic malignancies such as multiple myeloma (MM) remains to be ascertained. Therefore, we aimed to investigate the immunotyping distribution of serum monoclonal paraprotein and the environmental influence on MM and monoclonal gammopathy of uncertain significance (MGUS) in the Taiwanese population. MATERIALS AND METHODS Serum protein electrophoresis with immunosubtraction by the capillary zone electrophoresis method was performed as primary screening for MM and MGUS. Clinical, pathological, and residence data of patients were also obtained. RESULTS From August, 2013 to June, 2015, a total of 327 patients underwent serum protein electrophoresis with immunosubtraction. Among these, 281 demonstrated no remarkable findings or non-malignant oligoclonal gammopathy, 23 were detected to have MGUS, 18 were identified as MM, and a further 5 were found as other malignancies. The most frequent immunotyping distribution of serum monoclonal paraprotein was IgG kappa (54.3%, n=25), followed by IgA lambda (15.2%, n=7) and IgG lambda (10.9%, n=5) in subjects with gammopathy. Additionally, it was shown that the elderly (OR: 4.61, 95% CI: 1.88-11.30, P<0.01) and males (OR: 2.04, 95% CI: 1.04-4.02, P=0.04) had significantly higher risk of developing MM and MGUS. There was no obvious impact of environmental factors on the health risk of MM and MGUS evolution (OR: 0.77, 95% CI: 0.40-1.50, P=0.49). CONCLUSIONS The most frequent immunotyping distribution of serum monoclonal paraprotein included IgG kappa, IgA lambda and IgG lambda in MM and MGUS in the Taiwanese population. The elderly and male subjects are at significantly higher risk of MM and MGUS development, but there was no obvious impact of environmental factors on risk.
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Affiliation(s)
- Chih-Chun Chang
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan E-mail :
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21
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Huang RSP, Dasgupta A, Nguyen AND, Wahed A. Inability to Measure M-Protein With Capillary Zone Electrophoresis (CAPPILLARYS 2) in Tracings With NonDiscernable Peaks. J Clin Lab Anal 2014; 29:343-6. [PMID: 25130914 DOI: 10.1002/jcla.21776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/29/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We performed a retrospective study to illustrate the challenges with quantifying monoclonal (M)-protein in the cases of serum protein capillary zone electrophoresis (SPCZE) where no discernable peak is apparent. MATERIALS AND METHODS We retrospectively reviewed 160 serum immunofixation electrophoresis (SIFE) that were performed at Memorial Hermann Hospital-Texas Medical Center between October 2013 and November 2013 and we identified the positive SIFE results. The corresponding SPCZE of the positive SIFE were retrieved and evaluated for the ability to quantify M-proteins in them. We define the ability to quantify M-protein as the ability for the operator of the SPCZE to identify a discernable peak and to be able to manually gate the area under the peak. RESULTS Twenty-two cases of SIFE detected a monoclonal immunoglobulin. Of the corresponding 22 SPCZE, we could not quantify the M-protein in 6 (27.3%) of the cases. CONCLUSION We have shown several cases where we were not able to quantify the M-protein with SPCZE. This poses a challenge in the diagnosis and management of these patients.
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Affiliation(s)
- Richard S P Huang
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas
| | - Andy N D Nguyen
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas
| | - Amer Wahed
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas
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Huang RSP, Oleske DA, Tholpady A, Chang BN, Dasgupta A, Nguyen A, Wahed A. High false-positive rate for monoclonal gammopathy using capillary electrophoresis (CAPILLARYS 2) alone. J Clin Lab Anal 2014; 28:42-6. [PMID: 24375896 DOI: 10.1002/jcla.21641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 05/31/2013] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Capillary zone electrophoresis (CZE) is a newer method of performing serum protein electrophoresis and is considered to be faster and more efficient than agarose gel method. We decided to evaluate CZE as an efficient screening tool for monoclonal gammopathies, and we began recommending immunofixation studies in cases with such minor/subtle distortions to avoid missing monoclonal gammopathies. METHODS We evaluated 163 serum protein agarose gel electrophoresis (SPAGE) samples between October and November 2011, and 447 serum protein CZE (SPCZE) samples between January 2012 to February 2012 and August 2012 to September 2012. RESULTS Immunofixation studies were recommended in 51 of 163 cases (31.3%) performed by SPAGE, and in 274 of 447 cases (61.3%) performed by SPCZE. While using SPAGE, of the 51 cases recommended for immunofixation (24 were performed to date), six cases (25.0%) were positive for monoclonal gammopathy. In contrast, while using SPCZE, of the 274 cases recommended for immunofixation (118 were performed to date), 18 cases (15.2%) were positive for monoclonal gammopathy. Using the SPCZE method, of these 18 cases, five (27.8%) had minor/subtle distortions without obvious peaks. Our recommendation rate for immunofixation studies has thus almost doubled (61.3% vs. 31.3%) with the adoption of SPCZE. Yet, using SPCZE has not translated to detecting more cases of true monoclonal gammopathies. CONCLUSION Therefore, we conclude that there is a high false-positive rate for monoclonal gammopathy using CE alone.
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Affiliation(s)
- Richard Sheng Poe Huang
- Department of Pathology & Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
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Rodic P, Pavlovic S, Kostic T, Suvajdzic Vukovic N, Djordjevic M, Sumarac Z, Dajak M, Bonaci Nikolic B, Janic D. Gammopathy and B lymphocyte clonality in patients with Gaucher type I disease. Blood Cells Mol Dis 2013; 50:222-5. [DOI: 10.1016/j.bcmd.2012.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 11/24/2012] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
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24
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Poisson J, Fedoriw Y, Henderson MP, Hainsworth S, Tucker K, Uddin Z, McCudden CR. Performance evaluation of the Helena V8 capillary electrophoresis system. Clin Biochem 2012; 45:697-9. [DOI: 10.1016/j.clinbiochem.2012.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/20/2012] [Accepted: 03/09/2012] [Indexed: 11/28/2022]
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25
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Csako G. Immunofixation electrophoresis for identification of proteins and specific antibodies. Methods Mol Biol 2012; 869:147-171. [PMID: 22585484 DOI: 10.1007/978-1-61779-821-4_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Immunofixation electrophoresis (IFE) is a technique for the identification of proteins within complex mixtures after separation by either conventional zone electrophoresis or isoelectric focusing. Most commonly antigens (which are often immunoglobulins) are separated by electrophoresis followed by precipitation with specific antibodies in situ. However, immunoglobulins with specific reactivity can be also precipitated with the proper antigens after electrophoresis in reverse or reversed IFE. Because of its great versatility, potentially high sensitivity, ease to perform and customize, and relatively low cost with no requirement for expensive instrumentation, manual IFE remains a valuable tool for both clinical diagnostic testing and research. Any low-viscosity body fluid specimen or, possibly, culture fluid could be tested with IFE if proper antibodies (or antigens in reverse[d] IFE) are available. After pretreatment with chaotropic and/or reducing agents, even high-viscosity specimens might be amenable to testing with IFE.
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Affiliation(s)
- Gyorgy Csako
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
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26
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Evaluation of two automated capillary electrophoresis systems for human serum protein analysis. Clin Biochem 2011; 44:1473-9. [DOI: 10.1016/j.clinbiochem.2011.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 05/19/2011] [Accepted: 05/20/2011] [Indexed: 11/19/2022]
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27
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Cho SY, Kim Y, Lee A, Park TS, Lee HJ, Suh JT. Three Cases Showing False Results in the Detection of Monoclonal Components Using Capillary Electrophoresis. Lab Med 2011. [DOI: 10.1309/lmhzlimxvylwt7sq] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gastric bypass is not associated with protein malnutrition in morbidly obese patients. Obes Surg 2008; 19:840-4. [PMID: 18696170 DOI: 10.1007/s11695-008-9627-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 06/25/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients undergoing bariatric surgery with a gastric bypass lose about 66% of excess weight. Although this procedure induces weight loss, it is unknown whether it leads to protein malnutrition, which is studied here. METHODS One hundred ten obese patients (body mass index, 47.9 +/- 8.6 kg/m(2)) undergoing gastric bypass had a measurement of plasma albumin and transthyretin (formerly prealbumin) and a calculation of nutritional risk index (NRI) before and throughout the 2 years following the surgery. RESULTS All but five patients lost more than 15% of initial weight; the mean loss of excess weight was 65.2 +/- 26.4% at 2 years. Plasma concentrations of albumin and transthyretin decreased after surgery, but while albumin returned to initial values after 12 months, transthyretin remained low. Only one patient had an albumin below 30 g/l; another one had a transthyretin lower than 110 mg/l. All NRI scores were lower than 83.5 (62 +/- 5, ranging 44-70), qualifying patients for severe malnutrition. CONCLUSION Malnutrition is difficult to diagnose in obese patients undergoing surgery. The large weight loss is most often not associated with protein malnutrition. Whether gastric bypass induces protein malnutrition remains to be established.
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Altinier S, Sarti L, Varagnolo M, Zaninotto M, Maggini M, Plebani M. An expert system for the classification of serum protein electrophoresis patterns. Clin Chem Lab Med 2008; 46:1458-63. [DOI: 10.1515/cclm.2008.284] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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