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Visual examination of electrophoretic patterns by a pathologist is the most sensitive method of detecting monoclonal proteins since small bands may be obscured in densitometric scans. It should be noted that immunoglobulins often can be found throughout the electrophoretic spectrum. Fanning SR, Hussein MA. A serum free light chain ratio is indicated in the case of a negative immunofixation result when the suspicion for multiple myeloma is still high. Rarely, plasma cells can enter into the circulation and if they represent 20 percent or more of the blood cells, the condition is called plasma cell leukemia. Note that the percent of plasma cells in the bone marrow, assessed by flow cytometry, is not the value used in the diagnostic criteria above. Immunofixation detects monoclonal proteins in serum and urine Following my rotation in Anatomical Pathology, I spent one week on accessioning review and another three in Chemistry. When screening a patient or establishing a first-time diagnosis for a monoclonal gammopathy, consider ordering DMOGA / Monoclonal Gammopathy, Diagnostic, Serum instead, which includes free light chain analysis. How Is a Serum Immunofixation Test Done? Do You Need It? - WebMD The pattern of serum protein electrophoresis results depends on the fractions of two major types of protein: albumin and globulins. If the sample is hemolyzed in vitro (red blood cells are ruptured outside the body such as during traumatic blood draw), there will be free hemoglobin, which migrates to the 1 fraction. Copyright 2005 by the American Academy of Family Physicians. On the contrary, a persistent monoclonal protein despite treatment is a sign of refractory disease. Electrophoresis separates proteins based on their physical properties, and the subsets of these proteins are used in interpreting the results. Urine IFE tests are often done if IFE blood test results were not normal. These include: You may need testing if you have symptoms of certain diseases, such as multiple myeloma, multiple sclerosis, malnutrition, or malabsorption. You can also contact us directly if you need to. Clin Chem. M protein is made by abnormal plasma cells. Ceruloplasmin, alpha2-macroglobulin, and haptoglobin contribute to the alpha2-protein band. Monoclonal Protein on Serum Protein Electrophoresis (M Component) Finally, the sample is washed to remove the proteins that do not precipitate and then stained, destained, and dried. Serum Immunofixation Test: Purpose, Procedure, and Results - Healthline Many subspecialists. There are two main types of proteins in the blood: albumin and globulin. Patients with monoclonal gammopathy of undetermined significance require close follow-up because about 1 percent per year develop multiple myeloma or another malignant monoclonal gammopathy.13 [Evidence level B, prospective cohort study] An algorithm for the follow-up of patients with a monoclonal gammopathy is provided in Figure 3.6.