Serum Protein Electrophoresis | Myeloma Screen - MedSchool
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Serum protein electrophoresis (EPG) separates serum proteins based on their electrical charge, producing a characteristic pattern.
 

Serum Protein Electrophoresis

 
 
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Overview

  • Serum protein electrophoresis (EPG) separates serum proteins based on their electrical charge, producing a characteristic pattern.
  • Electrophoresis is a useful screening test for plasma cell neoplasms such as multiple myeloma and MGUS. If a plasma cell neoplasm is suspected then serum EPG should be ordered in conjunction with immunofixation electrophoresis (IFE) in order to quantify a paraprotein if present.
    • Elements of Protein Electrophoresis

    • Albumin
    • Alpha-1 - alpha 1-antitrypsin, thyroid-binding globulin
    • Alpha-2 - caeruloplasmin, alpha 2-macroglobulin, haptoglobulin
    • Beta-1 - transferrin
    • Beta-2 -  beta-lipoprotein
    • Gamma - immunoglobulins
  • The elements of the complement pathway are present between the beta and gamma bands.

Albumin

  • The most abundant serum protein, produced by the liver. Important in maintaining oncotic pressure and transporting certain hydrophobic compounds.
    • Significance of Elevated Albumin

    • Indicative of dehydration.
    • Causes of Hypoalbuminaemia

    • Malnutrition
    • Hepatic synthetic dysfunction
    • Chronic infection
    • Protein-losing enteropathies
    • Nephrotic syndrome
    • Severe burns
    • Pregnancy

Alpha-1 Globulins

  • Include alpha-1 antitrypsin and thyroid-binding globulin.
    • Causes of Elevated Alpha-1 Globulins

    • Acute inflammation
    • Malignancy
    • Pregnancy
    • Causes of Decreased Alpha-1 Globulins

    • Alpha-1 antitrypsin deficiency
    • Nephrotic syndrome
    • Cirrhosis

Alpha-2 Globulins

  • Include caeruloplasmin, alpha 2-macroglobulin and haptoglobulin.
    • Causes of Elevated Alpha-2 Globulins

    • Acute inflammation
    • Adrenal insufficiency
    • Corticosteroid administration
    • Nephrotic syndrome
    • Cirrhosis
    • Causes of Decreased Alpha-2 Globulins

    • Malnutrition
    • Haemolytic anaemia
    • Protein-losing enteropathies

Beta Globulins

  • The beta-1 band is mostly transferrin, while the beta-2 band is mostly beta-lipoprotein.
    • Causes of Elevated Beta Globulins

    • Iron deficiency anaemia
    • Hypothyroidism
    • Cushing’s
    • Biliary obstruction
    • Polyarteritis nodosa
    • Causes of Decreased Beta Globulins

    • Malnutrition

Gamma Globulins

  • Represents serum immunoglobulins IgG, IgM, IgA, IgD and IgE.
  • It is important to determine whether an elevated gamma globulin band is polyclonal (generalised elevation) or monoclonal (elevation of a small part of the band).
    • Polyclonal Gammopathy

    • Gamma Globulins
    • Causes of Polyclonal Gammopathy

    • Infection
    • Inflammatory disease
    • Malignancy
    • Monoclonal Gammopathy

    • Gamma Globulins
    • Causes of Monoclonal Gammopathy

    • Plasma Cell Neoplasms

    • Monoclonal gammopathy of unclear significance (MGUS)
    • Smouldering myeloma
    • Multiple myeloma
    • Solitary plasmacytoma
    • AL amyloidosis
    • Others

    • Waldenstrom’s macroglobulinaemia
    • Chronic lymphocytic leukaemia (CLL)
    • Non-Hodgkin lymphoma
    • Monoclonal (type II) cryoglobulinaemia
    • Hypogammaglobulinaemia

    • Causes of Hypogammaglobulinaemia

    • Inherited

    • Primary hypogammaglobulinaemia
    • Reduced Production

    • Malnutrition
    • Malignancy - especially CLL, lymphoma, multiple myeloma
    • Inflammatory disease - SLE, RA
    • Viruses - HIV, EBV, CMV, rubella
    • Increased Consumption

    • Sepsis
    • Severe burns
    • Protein-losing enteropathy
    • Nephrotic syndrome
Last updated on August 12th, 2018
 
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