Role of serum protein electrophoresis in clinically suspected cases of plasma cell dyscrasia
A tertiary care center experience from North India
Keywords:
Serum protein electrophoresis, monoclonal gammopathy, plasma cell dyscrasia
Abstract
Background: Serum protein electrophoresis (SPE) and its pattern recognition is an excellent screening technique for the detection of paraproteinemias or monoclonal gammopathies. In this study, we assessed SPE patterns in all clinically suspected cases of plasma cell dyscrasia with usual and unusual clinical presentations and correlated with ancillary investigations. Method: We analysed serum protein electrophoresis (SPE) patterns in clinically suspected cases of plasma cell dyscrasia in 2 year duration. Based on SPE pattern these cases were divided into two groups: Group I, with M-component and Group II, without M-component. These cases were reviewed with respect to clinical presentation and correlated with immunofixation electrophoresis and bone marrow aspiration/biopsy findings wherever available, especially in the M band positive cases to differentiate multiple myeloma (MM) from the other conditions. Result: A total of 80 samples were received for SPE, out of these, 56.3% were clinically suspected to have plasma cell dyscrasia. Among these cases 60% were in group I and 40% were in group II. In group II, 39% cases were essentially non neoplastic after relevant investigations. In group I, M-band was observed in 88.9% cases in γ-region and 11.1% cases in β-region. The mean fraction of the M protein was 4.7g/dl with a range of 2.0g/dl to 9.8g/dl. In group II 72.2% showed polyclonal hypergammaglobulinemia, 22.2% showed normal electrophoretic pattern and 5.6% showed hypogammaglobulinemia. Bone marrow aspiration and biopsy were available in 88.9% of all suspected cases. Various haematological neoplasms observed in both the groups, their clinical presentations with interesting facets of the cases have been discussed. Conclusion: Serum protein electrophoresis is one of the most important diagnostic modality in clinical chemistry. It helps to resolve cases with bone marrow plasmacytosis particularly in differentiating between reactive non-neoplastic plasmacytic proliferations from clonal plasma cell disorders. Moreover, it also facilitates the work-up of cases with atypical presentations and thereby paves way to clinch the diagnosis in these ambiguous cases.References
1. Tiselius A. Electrophoresis of serum globulin. I. Biochem J 1937;31:313-17. 2. Kyle RA. Sequence of testing for monoclonal gammopathies: serum and urine assays. Archives of Pathology and Laboratory Medicine. 1999 Feb;123(2):114-8.
3. Chopra GS, Gupta PK, Mishra DK. Evaluation of suspected monoclonal gammopathies: Experience in a tertiary care hospital. Medical Journal Armed Forces India. 2006 Apr 1;62(2):134-7.
4. Tripathy S. The role of serum protein electrophoresis in the detection of multiple myeloma: An experience of a corporate hospital. Journal of clinical and diagnostic research. 2012 Nov;6(9):1458.
5. Nayak BS, Mungrue K, Gopee D, Friday M, Garcia S, Hirschfeld E, et al. Epidemiology of multiple myeloma and the role of M-band detection on serum electrophoresis in a small developing country. A retrospective study. Archives of physiology and biochemistry. 2011 Oct 1;117(4):236–40.
6. Owen RG, Parapia LA, Higginson J, Misbah SA, Child JA, Morgan GJ, et al. Clinicopathological correlates of IgM paraproteinemias. Clinical lymphoma. 2000 Jun 1;1(1):39-43.
7. Bhatt VR, Murukutla S, Naqi M, Pant S, Kedia S, Terjanian T. IgM Myeloma or Waldenstrom’s Macroglobulinemia Is the Big Question? Maedica. 2014;9(1):72–5.
8. Uljon SN, Treon SP, Tripsas CK, Lindeman NI. Challenges with serum protein electrophoresis in assessing progression and clinical response in patients with Waldenström macroglobulinemia. Clinical Lymphoma Myeloma and Leukemia. 2013 Apr 1;13(2):247-9.
9. Paolini L, Di Noto G, Maffina F, Martellosio G, Radeghieri A, Luigi C, et al. Comparison of HevyliteTM IgA and IgG assay with conventional techniques for the diagnosis and follow-up of plasma cell dyscrasia.. Annals of clinical biochemistry. 2015 May;52(3):337-45.
10. Tseng CH, Chang CY, Liu KS, Liu FJ. Accuracy of serum IgM and IgA monoclonal protein measurements by densitometry. Annals of Clinical & Laboratory Science. 2003 Apr 1;33(2):160-6.
11. Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21–33.
12. Kumar S, Sengupta RS, Kakkar N, Sharma A, Singh S, Varma S. Skin involvement in primary systemic amyloidosis. Mediterranean journal of hematology and infectious diseases. 2013;5(1):e2013005.
13. Finkel KW, Cohen EP, Shirali A, Abudayyeh A. Paraprotein–Related Kidney Disease: Evaluation and Treatment of Myeloma Cast Nephropathy. Clinical Journal of the American Society of Nephrology. 2016;11(12):2273-79.
14. Kamihira S, Taguchi H, Kinoshita K, Ichimaru M. Monoclonal gammopathy in adult T-cell leukemia/lymphoma: A report of three cases. Japanese journal of clinical oncology. 1984 Dec 1;14(4):699-704.
15. Durie BGM, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K, et al. International uniform response criteria for multiple myeloma. Leukemia. 2006;20(9):1467–73.
16. Drayson M, Tang LX, Drew R, Mead GP, Carr-smith H, Bradwell AR. Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma Brief report Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood. 2001 May 1;97(9):2900-2.
17. Susnerwala SS, Shanks JH, Banerjee SS, Scarffe JH, Farrington WT, Slevin NJ. Extramedullary plasmacytoma of the head and neck region: Clinicopathological correlation in 25 cases. British Journal of cancer. 1997 Mar;75(6):921.
18. Soutar R, Lucraft H, Jackson G, Reece A, Bird J, Low E, Samson D. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. British journal of haematology. 2004 Mar;124(6):717-26.
19. Wilder RB, Ha CS, Cox JD, Weber D, Delasalle K, Alexanian R. Persistence of myeloma protein for more than one year after radiotherapy is an adverse prognostic factor in solitary plasmacytoma of bone. Cancer. 2002 Mar 1;94(5):1532-7.
20. Keren D. Protein electrophoresis in clinical diagnosis. CRC Press; 2003 Sep 26.
21. Mouzaki A, Matthes T, Miescher PA, Beris P. Polyclonal hypergammaglobulinemia in a case of B‐cell chronic lymphocytic leukaemia: the result of IL‐2 production by the proliferating monoclonal B cells?. British journal of haematology. 1995 Oct;91(2):345-9.
3. Chopra GS, Gupta PK, Mishra DK. Evaluation of suspected monoclonal gammopathies: Experience in a tertiary care hospital. Medical Journal Armed Forces India. 2006 Apr 1;62(2):134-7.
4. Tripathy S. The role of serum protein electrophoresis in the detection of multiple myeloma: An experience of a corporate hospital. Journal of clinical and diagnostic research. 2012 Nov;6(9):1458.
5. Nayak BS, Mungrue K, Gopee D, Friday M, Garcia S, Hirschfeld E, et al. Epidemiology of multiple myeloma and the role of M-band detection on serum electrophoresis in a small developing country. A retrospective study. Archives of physiology and biochemistry. 2011 Oct 1;117(4):236–40.
6. Owen RG, Parapia LA, Higginson J, Misbah SA, Child JA, Morgan GJ, et al. Clinicopathological correlates of IgM paraproteinemias. Clinical lymphoma. 2000 Jun 1;1(1):39-43.
7. Bhatt VR, Murukutla S, Naqi M, Pant S, Kedia S, Terjanian T. IgM Myeloma or Waldenstrom’s Macroglobulinemia Is the Big Question? Maedica. 2014;9(1):72–5.
8. Uljon SN, Treon SP, Tripsas CK, Lindeman NI. Challenges with serum protein electrophoresis in assessing progression and clinical response in patients with Waldenström macroglobulinemia. Clinical Lymphoma Myeloma and Leukemia. 2013 Apr 1;13(2):247-9.
9. Paolini L, Di Noto G, Maffina F, Martellosio G, Radeghieri A, Luigi C, et al. Comparison of HevyliteTM IgA and IgG assay with conventional techniques for the diagnosis and follow-up of plasma cell dyscrasia.. Annals of clinical biochemistry. 2015 May;52(3):337-45.
10. Tseng CH, Chang CY, Liu KS, Liu FJ. Accuracy of serum IgM and IgA monoclonal protein measurements by densitometry. Annals of Clinical & Laboratory Science. 2003 Apr 1;33(2):160-6.
11. Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21–33.
12. Kumar S, Sengupta RS, Kakkar N, Sharma A, Singh S, Varma S. Skin involvement in primary systemic amyloidosis. Mediterranean journal of hematology and infectious diseases. 2013;5(1):e2013005.
13. Finkel KW, Cohen EP, Shirali A, Abudayyeh A. Paraprotein–Related Kidney Disease: Evaluation and Treatment of Myeloma Cast Nephropathy. Clinical Journal of the American Society of Nephrology. 2016;11(12):2273-79.
14. Kamihira S, Taguchi H, Kinoshita K, Ichimaru M. Monoclonal gammopathy in adult T-cell leukemia/lymphoma: A report of three cases. Japanese journal of clinical oncology. 1984 Dec 1;14(4):699-704.
15. Durie BGM, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K, et al. International uniform response criteria for multiple myeloma. Leukemia. 2006;20(9):1467–73.
16. Drayson M, Tang LX, Drew R, Mead GP, Carr-smith H, Bradwell AR. Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma Brief report Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood. 2001 May 1;97(9):2900-2.
17. Susnerwala SS, Shanks JH, Banerjee SS, Scarffe JH, Farrington WT, Slevin NJ. Extramedullary plasmacytoma of the head and neck region: Clinicopathological correlation in 25 cases. British Journal of cancer. 1997 Mar;75(6):921.
18. Soutar R, Lucraft H, Jackson G, Reece A, Bird J, Low E, Samson D. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. British journal of haematology. 2004 Mar;124(6):717-26.
19. Wilder RB, Ha CS, Cox JD, Weber D, Delasalle K, Alexanian R. Persistence of myeloma protein for more than one year after radiotherapy is an adverse prognostic factor in solitary plasmacytoma of bone. Cancer. 2002 Mar 1;94(5):1532-7.
20. Keren D. Protein electrophoresis in clinical diagnosis. CRC Press; 2003 Sep 26.
21. Mouzaki A, Matthes T, Miescher PA, Beris P. Polyclonal hypergammaglobulinemia in a case of B‐cell chronic lymphocytic leukaemia: the result of IL‐2 production by the proliferating monoclonal B cells?. British journal of haematology. 1995 Oct;91(2):345-9.
Published
2020-01-28
Issue
Section
Original Article
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
