Continuing Medical Education

Laboratory testing in the evaluation of a monoclonal protein: A practical framework for interpretation

B L Houston, E Rimmer, R Zarychanski, M Seftel

Abstract


Monoclonal proteins are immunoglobulins secreted by identical but abnormal plasma cells that are clones of a parent cell. While routine screening in the absence of signs or symptoms of disease is not recommended, testing is indicated in the diagnostic work-up for multiple myeloma and other plasma cell disorders. When indicated, a serum protein electrophoresis with immunofixation and serum free light-chain assay should be performed to determine the type and quantity of monoclonal protein. Using a case-based approach, we highlight common misconceptions with monoclonal protein investigations, and suggest a practical framework for diagnostic interpretation.


Authors' affiliations

B L Houston, Section of Hematology and Medical Oncology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada

E Rimmer, Section of Hematology and Medical Oncology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada

R Zarychanski, Section of Hematology and Medical Oncology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada

M Seftel, Section of Hematology and Medical Oncology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; and Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada

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Keywords

Monoclonal gammopathy; Serum protein electrophoresis; Immunofixation; Serum free light-chain assay; Plasma cell disorder; MGUS; Multiple myeloma

Cite this article

South African Medical Journal 2019;109(10):719-722. DOI:10.7196/SAMJ.2019.v109i10.14314

Article History

Date submitted: 2019-09-30
Date published: 2019-09-30

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