Serum Protein Electrophoresis

Aka: Serum Protein Electrophoresis, SPEP

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II. Mechanism

  1. Serum placed on charged surface
  2. Proteins separated by physical properties
    1. Net charge
    2. Size
    3. Shape

III. Indications

  1. Multiple Myeloma
    1. Most common indication
  2. Waldenstrom's Macroglobulinemia
  3. Primary Amyloidosis
  4. Hypoglobulinemia
  5. Peripheral Neuropathy without obvious cause
  6. Collagen vascular disease
  7. Nephrotic Syndrome
  8. Nutritional Deficiency
  9. Liver disease

IV. Albumin

  1. Peak characteristics
    1. First peak on left (closest to positive electrode)
    2. Largest peak
  2. Peak components
    1. Serum Albumin
  3. Normal: 3.6 to 5.2 g/dl
  4. Increased
    1. Dehydration
  5. Decreased
    1. Malnutrition
    2. Hemorrhage
    3. Burn Injury
    4. Protein losing Enteropathy
    5. Chronic Liver Disease
    6. Malabsorption
    7. Nephrotic Syndrome
    8. Systemic Lupus Erythematosus
    9. Pregnancy
    10. Burns

V. Alpha-1 Globulin

  1. Peak characteristics
    1. Second peak from left
  2. Peak components
    1. Alpha-1-antitrypsin
    2. Thyroid Binding Globulin
    3. Transcortin
  3. Normal: 0.15 to 0.4 g/dl
  4. Increased
    1. Neoplastic disease
    2. Acute and chronic infection
    3. Febrile reaction
    4. Inflammation
  5. Decreased
    1. Emphysema
    2. Nephrosis
    3. Alpha-1 Antitrypsin Deficiency

VI. Alpha-2 Globulin

  1. Peak characteristics
    1. Third peak from left
  2. Peak components
    1. Ceruplasmin
    2. Alpha-2-macroglobulin
    3. Haptoglobin
  3. Normal: 0.5 to 1.0 g/dl
  4. Increased
    1. Biliary Cirrhosis
    2. Obstructive Jaundice
    3. Multiple Myeloma (rarely)
    4. Ulcerative Colitis
    5. Neoplastic disease
    6. Inflammation
    7. Infection
    8. Nephrotic Syndrome
    9. Adrenal Insufficiency
    10. Diabetes Mellitus (advanced)
  5. Decreased
    1. Acute Hemolytic Anemia
    2. Megaloblastic Anemia
    3. Malnutrition
    4. Protein-losing Enteropathy
    5. Severe hepatocellular damage
    6. Wilson's Disease

VII. Beta Globulin

  1. Peak characteristics
    1. Fourth peak from left
    2. M-shaped, double peak
  2. Peak components
    1. Beta-1 peak
      1. Transferrin
    2. Beta-2 peak
      1. Beta-Lipoprotein
    3. Beta peak in general
      1. Serum complement
      2. Immunoglobulins (IgA, IgM, IgG)
        1. Primarily seen in Gamma peak
  3. Normal: 0.6 to 1.2 g/dl
  4. Increased
    1. Hypothyroidism
    2. Biliary Cirrhosis
    3. Obstructive Jaundice
    4. Multiple Myeloma (occasionally)
    5. Diabetes Mellitus
  5. Decreased
    1. Hypocholesterolemia
    2. Nephrosis

VIII. Gamma Globulin

  1. Also see Immunoglobulins
  2. Peak characteristics
    1. Farthest peak on right (at negative electrode end)
    2. Fifth peak from left
  3. Peak components
    1. Immunoglobulins (may be seen throughout SPEP)
    2. C-Reactive Protein (between beta and gamma peak)
  4. Normal: 0.6 to 1.6 g/dl
  5. Increased
    1. Chronic Infections
    2. Hepatic Disease
    3. Autoimmune Disease
    4. Collagen Vascular disease
    5. Multiple Myeloma
    6. Waldenstrom's macroglobulin
    7. Hodgkin's Lymphoma
    8. Chronic Lymphocytic Leukemia
  6. Decreased
    1. Agammaglobulinemia
    2. Hypogammaglobulinemia
    3. Nephrotic Syndrome

IX. Interpretation of abnormal spike

  1. See Serum Protein Electrophoresis Abnormality

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