Serum Immunofixation Electrophoresis | Myeloma Screen - MedSchool
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Serum Immunofixation Electrophoresis

 
 

Overview

  • Immunofixation is used with serum electrophoresis to determine the type and amount of monoclonal protein (M-protein, or paraprotein) present in a patient with a suspected plasma cell neoplasm, such as MGUS or multiple myeloma.
  • Immunofixation electrophoresis (IFE) is performed by separating plasma proteins by electrophoresis, followed by addition of specific antisera against each type of immunoglobulin.
    • Results of IFE

    • Type of immunoglobulin present - IgG, IgM, IgA, IgD or IgE
    • Type of light chain present - kappa or lambda
    • Amount of paraprotein (g/L)
  • Standard IFE assesses the levels of immunoglobulins IgG, IgA and IgM, as these are the most commonly present in plasma cell neplasms; IgE and IgD may be tested if required. IFE also assesses for kappa or lambda free light chains.
  • There is normally no monoclonal protein (paraprotein) present in serum. If there is a paraprotein present at a level that is quantifiable, a measure of the amount of paraprotein will be provided. This is important in the diagnosis of MGUS (<30g/L) and smouldering myeloma (>30g/L), as well as for estimating risk of progression to multiple myeloma.

Diagnostic Criteria

    • Monoclonal Gammopathy of Uncertain Significance (MGUS)

    • Serum monoclonal protein <30g/L
    • Clonal bone marrow plasma cells <10%
    • No evidence of end-organ damage (hypercalcaemia, renal dysfunction, anaemia, bony lesions) or amyloidosis
    • Smouldering Myeloma

    • Serum paraprotein >30g/L or urinary paraprotein >500mg/24h and/or bone marrow plasma cells 10-60%
    • No evidence of end-organ damage (hypercalcaemia, renal dysfunction, anaemia, bony lesions) or amyloidosis
    • Multiple Myeloma

    • Clonal bone marrow plasma cells >10%
    • AND evidence of end-organ damage (hypercalcaemia, renal dysfunction, anaemia, bony lesions)
    • OR presence of biomarkers - ≥60% clonal plasma cells; serum free light chain ratio ≥100; more than one focal lesion ≥5mm on MRI
Last updated on August 12th, 2018
 
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