Laboratory Tests and Diagnostic Procedures. Munshi NC, Jagannath S. Plasma cell neoplasms. Hematology: Basic Principles and Practice. Philadelphia, PA: Elsevier; chap Interpreting laboratory tests. Textbook of Family Medicine. Review provided by VeriMed Healthcare Network. Editorial team. Protein electrophoresis - serum SPEP. How the Test is Performed A blood sample is needed.
How to Prepare for the Test You may be asked not to eat or drink for 12 hours before this test. How the Test will Feel When the needle is inserted to draw blood, some people feel moderate pain. Why the Test is Performed Proteins are made from amino acids and are important parts of all cells and tissues.
Normal Results Normal value ranges are: Total protein: 6. Risks There is little risk involved with having your blood taken. The albumin level is decreased under circumstances in which there is less production of the protein by the liver or in which there is increased loss or degradation of this protein.
Malnutrition, significant liver disease, renal loss e. Burns also may result in a low albumin level. Levels of albumin are increased in patients with a relative reduction in serum water e. Moving toward the negative portion of the gel i. The alpha 1 -protein fraction is comprised of alpha 1 -antitrypsin, thyroid-binding globulin, and transcortin.
Malignancy and acute inflammation resulting from acute-phase reactants can increase the alpha 1 -protein band. A decreased alpha 1 -protein band may occur because of alpha 1 -antitrypsin deficiency or decreased production of the globulin as a result of liver disease. Ceruloplasmin, alpha 2 -macroglobulin, and haptoglobin contribute to the alpha 2 -protein band. The alpha 2 component is increased as an acute-phase reactant. The beta fraction has two peaks labeled beta 1 and beta 2.
Beta 1 is composed mostly of transferrin, and beta 2 contains beta-lipoprotein. IgA, IgM, and sometimes IgG, along with complement proteins, also can be identified in the beta fraction.
Much of the clinical interest is focused on the gamma region of the serum protein spectrum because immunoglobulins migrate to this region. It should be noted that immunoglobulins often can be found throughout the electrophoretic spectrum.
C-reactive protein CRP is located in the area between the beta and gamma components. Serum protein electrophoresis commonly is performed when multiple myeloma is suspected. Unexplained peripheral neuropathy not attributed to longstanding diabetes mellitus, toxin exposure, chemotherapy, etc. Hypercalcemia attributed to possible malignancy e. Information from references 2 through 4. Often, there are associated decreases in the albumin and transferrin levels.
Information from reference 6. In the interpretation of serum protein electrophoresis, most attention focuses on the gamma region, which is composed predominantly of antibodies of the IgG type. The gamma-globulin zone is decreased in hypogammaglobulinemia and agammaglobulinemia. Although many conditions can cause an increase in the gamma region, several disease states cause a homogeneous spike-like peak in a focal region of the gamma-globulin zone Figure 2.
Abnormal serum protein electrophoresis pattern in a patient with multiple myeloma. Note the large spike in the gamma region. It is extremely important to differentiate monoclonal from polyclonal gammopathies. Monoclonal gammopathies are associated with a clonal process that is malignant or potentially malignant. In contrast, polyclonal gammopathies may be caused by any reactive or inflammatory process, and they usually are associated with nonmalignant conditions.
The most common conditions in the differential diagnosis of polyclonal gammopathy are listed in Table 3. Viral infections, especially hepatitis, human immunodeficiency virus infection, mononucleosis, and varicella Focal or systemic bacterial infections, including endocarditis, osteomyelitis, and bacteremia Tuberculosis Connective tissue diseases Systemic lupus erythematosus Mixed connective tissue Temporal arteritis Rheumatoid arthritis Sarcoid Liver diseases Cirrhosis Ethanol abuse Autoimmune hepatitis Viral-induced hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis.
Information from references 8 and 9. An M protein is characterized by the presence of a sharp, well-defined band with a single heavy chain and a similar band with a kappa or lambda light chain. A polyclonal gammopathy is characterized by a broad diffuse band with one or more heavy chains and kappa and lambda light chains.
Once a monoclonal gammopathy is identified by serum protein electrophoresis, multiple myeloma must be differentiated from other causes of this type of gammopathy. The quantity of M protein can help differentiate multiple myeloma from monoclonal gammopathy of undetermined significance.
Definitive diagnosis of multiple myeloma requires 10 to 15 percent plasma cell involvement as determined by bone marrow biopsy. Characteristic differentiating features of the monoclonal gammopathies are listed in Table 4. M protein appears as a narrow spike in the gamma, beta, or alpha 2 regions.
M-protein level is usually greater than 3 g per dL. Skeletal lesions e. Diagnosis requires 10 to 15 percent plasma cell involvement on bone marrow biopsy. Anemia, pancytopenia, hypercalcemia, and renal disease may be present. There is less than 10 percent plasma cell involvement on bone marrow biopsy.
Affected patients have no M protein in their urine, no lytic bone lesions, no anemia, no hypercalcemia, and no renal disease. There is greater than 10 percent plasma cell involvement on bone marrow biopsy. Affected patients have no lytic bone lesions, no anemia, no hypercalcemia, and no renal disease. M-protein levels are low. Affected patients have few bone lesions and few hematologic disturbances.
This monoclonal gammopathy occurs in younger patients. Affected patients have only one tumor, with no other bone lesions and no urine or serum abnormalities.
Affected patients have hyperviscosity and hypercellular bone marrow with extensive infiltration by lymphoplasma cells. Multiple myeloma: recognition and management.
Am Fam Physician ; 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. The remainder had hypogammaglobulinemia or a normal-appearing pattern.
Consequently, urine protein electrophoresis is recommended in all patients suspected of having a plasma cell dyscrasia. An additional point to consider is the size of the M-protein spike. 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.
If multiple myeloma still is considered clinically in a patient who does not have an M-protein spike on serum protein electrophoresis, urine protein electrophoresis should be performed.
Monoclonal gammopathy is present in up to 8 percent of healthy geriatric patients. It can be used to diagnose a variety of conditions, including disorders of the immune system and a type of cancer called multiple myeloma. Other names for globulin tests: Serum globulin electrophoresis, total protein. What is it used for? Globulin tests can be used to help diagnose a variety of conditions, including: Liver damage or disease Kidney disease Nutritional problems Autoimmune disorders Certain types of cancer.
Why do I need a globulin test? These tests, called liver function tests, may be ordered if you are at risk for liver disease or have symptoms of liver disease, which may include: Jaundice , a condition that causes your skin and eyes to turn yellow Nausea and vomiting Itching Recurring fatigue Fluid buildup in the abdomen, feet, and legs Loss of appetite A serum protein electrophoresis test measures gamma globulins and other proteins. This test may be ordered to diagnose disorders related to the immune system , including: Allergies Autoimmune diseases such as lupus and rheumatoid arthritis Multiple myeloma, a type of cancer.
What happens during a globulin test? Will I need to do anything to prepare for the test? Are there any risks to the test? What do the results mean? Atlanta: American Cancer Society Inc. What is multiple myeloma? New York: American Liver Foundation; c Liver Function Tests; [updated Jan 25; cited Feb 2]; [about 4 screens]. Selective IgA Deficiency [cited Feb 2]; [about 3 screens]. Washington D. Monitoring multiple myeloma patients treated with daratumumab: teasing out monoclonal antibody interference.
Bethesda MD : U. Understanding and Interpreting Serum Protein Electrophoresis.
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