Multiple Myeloma: A Case of Atypical Presentation on Protein Electrophoresis

Abstract

Multiple myeloma is a group of B-cell disorders resulting in the secretion of a specific and unique monoclonal immunoglobulin (M-protein). Protein electrophoresis is advised whenever multiple myeloma is suspected. The monoclonal protein migrates as a single entity in the electric field and is detected by the non-specific protein stain as a more intensely stained band superimposed on the usual protein pattern. The M-protein usually migrates in the gamma or beta region of the normal protein pattern; very rarely it may appear in the a2 or even in a1 region. Here we have given an atypical case presentation where the patient with multiple myeloma presented with two M-spike one each in a2 and b-globulin region on agarose gel protein electrophoresis with hypoglobulinemia but with reversed A:G ratio.

Serm Immuno Fixation Electrophoresis as a Diagnostic Method for Monoclonal Gammopathies in Patients with Multiple Myeloma

“…These results were agree with the results of O'connell et al [19] they` found increase amount of γ-globulin [20] and decreasing albumin levels in multiple myeloma patients [12] [19]. M-protein is commonly seen as a restricted band which is frequently observed on γ or β globulin district, also it may be observed on α2 globulin range but this is as very unusual situation [12]. The SPEP is limited at low monoclonal immunoglobulins levels [21], so in order to increase the sensitivity by utilizing of SIFE for diagnosing of the monoclonal immunoglobulins, and to categorize the light or heavy chain isotype, so it should be utilized SPEP and SIFE tests together for the identification of suspected multiple myeloma [13] [22], and to attain additional specific information about the kind of abnormal antibodies present [23].…”

“…The huge peak of γ-globulin area is sharp relatively. These results were agree with the results of O'connell et al [19] they` found increase amount of γ-globulin [20] and decreasing albumin levels in multiple myeloma patients [12] [19]. M-protein is commonly seen as a restricted band which is frequently observed on γ or β globulin district, also it may be observed on α2 globulin range but this is as very unusual situation [12].…”

“…Figures 4 and 5 represents SIFE for the patients with MM type IgG kappa and healthy individuals respectively. In the clarification of SPEP, more attentiveness is pointed to the gamma area, which is largely consisting of immunoglobulin [12].Various disorders can be due to a raise in the gamma area, but the one with a homogenous point in the gamma globulin area had unusual attention [13]. Monoclonal gammopathies are results of the multiplying of alone, normally malignant clone of plasma cells, which result from of alone class of immunoglobulins [14], heavy or light chains or both.…”

A Case of Multiple Myeloma with Unusual Serum Protein Electrophoresis

“…In our patient, the M band on the alpha-2 region was shown to be bound to IgA like a few others. 9,10 So, this case reminds that, M band on alpha-2 region in serum protein electrophoresis can rarely be seen in IgA myeloma patients.…”

“…Renal failure, defined as a serum creatinine ≥2 mg/dl at the time of diagnosis, is seen in 21% of patients. 9,10 In the patient, the M band on the α 2 region and β region was shown to be bound to IgA. The conventional technique serum electrophoresis is still widely used for the demonstration of M-Protein in the myeloma patient and it remains a gold standard.…”