Recommendations for standardized reporting of protein electrophoresis in Australia and New Zealand

Abstract

Recommendations are provided for standardized reporting of protein electrophoresis in Australia and New Zealand. It is expected that such standardized reporting formats will reduce both variation between laboratories and the risk of misinterpretation of results.

A triclonal gammopathy in a relapsing multiple myeloma patient, detected by immunosubtraction method

“…Quick and automated reporting and easy interpretation are advantages of CZE-immunosubtraction method over gel electrophoresis. Although according to the comparison studies and recommendations for standardized reporting of protein electrophoresis, the detection limit for paraprotein of immunosubtraction method is reported to be higher than IFE 15 and non-IgG paraproteins are poorly detected, 12 for this particular patient, we have detected the triclonality and especially IgA k by immunosubtraction method using CZE which was not obvious in IFE. Currently, triclonal gammopathy incidence and importance is unknown, but with the emergence of new technologies and methods, patients with different monoclonal patterns may be diagnosed accurately leading us to a more precise approach to these patients.…”

Screening immunofixation should replace protein electrophoresis as the initial investigation of monoclonal gammopathy: Point

“…The objective detection of a paraprotein by sIFE as the initial procedure, followed by quantification and characterisation of the paraprotein Of the available diagnostic techniques standard agarose or capillary PE has the worst ability to detect paraproteins with a detection limit of 0.5-1 g/L that depends on background staining of residual polyclonal immunoglobulin. This is further degraded when these bands migrate in non-γ regions [2,3]. All newly detected bands with a localised migration on PE needs to be further investigated with IFE to confirm monoclonality.…”

“…The presence, size and composition of paraproteins are of interest to clinicians in the diagnosis, risk stratification and monitoring of the monoclonal gammopathies and clinical laboratories have developed elaborate protocols and guidelines to satisfy these requirements [3]. The contribution of protein electrophoresis to the diagnosis of nephrotic syndrome, liver cirrhosis, acute inflammation and other conditions is marginal at best and will not be further considered as more appropriate investigations are available.…”

“…There is no mandatory requirement for the presence of a paraprotein or a minimum size with approximately 3% of multiple myeloma classified as non-secretory. It is also recognised that in light chain amyloidosis and Waldenstrom macroglobulinaemia the paraprotein can be so small that a sensitive detection method, such as IFE, is mandatory in the diagnostic workup [3,5,15]. The presence of a paraprotein is not sine qua non for the diagnosis of myeloma or myeloma related conditions, with the exception of MGUS.…”

“…Conventional IFE with sequential application of antibody directed against heavy (G, A, M, D and E) and light (κ, λ) chains is the standard method for characterisation and confirmation of monoclonality. This technique is also capable of detecting smaller bands of 50-100 mg/L in serum and as low as 5 mg/L in urine that has resulted in this technique being specified to define the absence of a monoclonal band and to classify the therapeutic response categories [3,16,18].…”