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Myeloma Screen

Serum Protein Electrophoresis

February 15th, 2021


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.


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).

Serum Paraprotein

  • Serum Paraprotein
  • 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

Polyclonal Gammopathy

  • Polyclonal Gammopathy
  • Causes of Polyclonal Gammopathy

  • Infection
  • Inflammatory disease
  • Malignancy
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