Detection by immunofixation of M proteins in hypogammaglobulinemic patients with normal serum protein electrophoresis results

Renuka Lakshminarayanan, Yueju Li, Kim Janatpour, Laurel A Beckett, Ishwarlal Jialal

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Serum protein electrophoresis (SPE) demonstrates a monoclonal protein as an M spike in the majority of patients with monoclonal gammopathies. However, in patients with an apparently normal SPE pattern or hypogammaglobulinemia, immunofixation electrophoresis (IFE) can reveal an M protein. We undertook this study to determine the yield of reflex IFE testing in patients with hypogammaglobulinemia and to identify any laboratory or biochemical parameters that would predict a positive IFE result. We evaluated 380 patients with hypogammaglobulinemia and a normal SPE pattern. Of 380, 37 (9.7%) had a positive IFE result in serum, urine, or both. Of the other laboratory values evaluated, a high α2-globulin level with an increased α2- globulin/α1-globulin ratio, a low hemoglobin level, and an elevated creatinine level predicted a positive IFE result. There was a 2-fold increase in the odds ratio for a positive IFE result when the α2-globulin/α1-globulin ratio was elevated. We recommend reflex IFE testing in patients with hypogammaglobulinemia with a normal SPE pattern if any of the following are present: elevated α2-globulin/α1-globulin ratio, low hemoglobin level, and elevated creatinine level.

Original languageEnglish (US)
Pages (from-to)746-751
Number of pages6
JournalAmerican Journal of Clinical Pathology
Volume127
Issue number5
DOIs
StatePublished - May 2007

Keywords

  • Hypogammaglobulinemia; M (monoclonal) protein
  • Immunofixation electrophoresis
  • Plasma cell dyscrasia
  • Serum protein electrophoresis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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