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Category: Immunology
Strategy for Detecting and Following Monoclonal Gammopathies, Page 1 of 2
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The preceding chapters in this section have dealt with several aspects of serum and urine protein analysis for immunoglobulins. Overwhelmingly, the single most important reason for performing these studies is to detect monoclonal gammopathies. This chapter briefly summarizes the various plasma cell proliferative diseases and then describes the use of the electrophoretic and nephelometric assays for the diagnosis, prognosis, and monitoring of monoclonal gammopathies. There are some general strategies for all laboratories as well as specific tests that are needed, depending on the disease presentation.
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Normal serum protein electrophoresis (PEL) and immunofixation electrophoresis (IFE). The gel scan (electropherogram) is aligned above the PEL gel. Alb, albumin; ELP, electropherogram.
Normal serum protein electrophoresis (PEL) and immunofixation electrophoresis (IFE). The gel scan (electropherogram) is aligned above the PEL gel. Alb, albumin; ELP, electropherogram.
Monoclonal gammopathy serum protein electrophoresis (PEL) and immunofixation electrophoresis (IFE). The gel scan (electropherogram) is aligned above the PEL gel. The dashed lines on both sides of the M protein indicate the M-spike fraction.
Monoclonal gammopathy serum protein electrophoresis (PEL) and immunofixation electrophoresis (IFE). The gel scan (electropherogram) is aligned above the PEL gel. The dashed lines on both sides of the M protein indicate the M-spike fraction.
Light-chain multiple myeloma serum (left) and urine (right) tested by PEL and IFE.
Light-chain multiple myeloma serum (left) and urine (right) tested by PEL and IFE.
Primary amyloid tested by serum (left) and urine (right) PEL and IFE.
Primary amyloid tested by serum (left) and urine (right) PEL and IFE.
Large M protein with suppressed polyclonal immunoglobulins.
Large M protein with suppressed polyclonal immunoglobulins.
Small M protein within a background of polyclonal immunoglobulins.
Small M protein within a background of polyclonal immunoglobulins.
(A) Use of ISE to estimate the area of small beta-migrating M proteins. Capillary electropherogram with beta region restriction and hypogammaglobulinemia. (B) Immunosubtraction demonstrating that anti-IgA and anti-L subtract the M protein in the mid-beta region. (C) Use ISE data to demarcate and measure the M protein concentration.
(A) Use of ISE to estimate the area of small beta-migrating M proteins. Capillary electropherogram with beta region restriction and hypogammaglobulinemia. (B) Immunosubtraction demonstrating that anti-IgA and anti-L subtract the M protein in the mid-beta region. (C) Use ISE data to demarcate and measure the M protein concentration.
Monoclonal gammopathies from the Mayo Clinic, 1960 to 2008
Monoclonal gammopathies from the Mayo Clinic, 1960 to 2008
Distribution of monoclonal proteins in patients with multiple myeloma and monoclonal gammopathies of undetermined significance
Distribution of monoclonal proteins in patients with multiple myeloma and monoclonal gammopathies of undetermined significance
Diagnostic sensitivities of monoclonal gammopathy screening panels with combinations of serum PEL, serum IFE, serum FLC, and/or urine IFE-PEL
Diagnostic sensitivities of monoclonal gammopathy screening panels with combinations of serum PEL, serum IFE, serum FLC, and/or urine IFE-PEL
Response criteria for FLC determination a
International Myeloma Working Group criteria for response to therapy
International Myeloma Working Group criteria for response to therapy