Serum Protein Electrophoresis Abnormality

Aka: Serum Protein Electrophoresis Abnormality, M-Spike, Paraproteinemia, Polyclonal Gammopathy

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II. Findings: Monoclonal Gammopathy (M-Spike)

  1. General
    1. Paraprotein peak present (Paraproteinemia)
    2. Associated with malignancy
    3. Sharp spike M-Band
      1. Contrast with broad polyclonal band (see below)
  2. Causes
    1. Multiple Myeloma
      1. Narrow M-Protein spike >3 g/dl
      2. Lytic skeletal lesions, Pancytopenia, Renal Failure
    2. Monoclonal Gammopathy of Undetermined Significance (MGUS)
    3. Benign Paraproteinemia (essential Paraproteinemia)
    4. Waldenstrom Macroglobulinemia
      1. M Protein: IgM
      2. Hyperviscosity and hypercellular Bone Marrow
    5. Plasmacytoma
    6. Amyloidosis
    7. Plasma cell Leukemia
      1. M-Protein: Low levels
      2. Peripheral blood with >20% plasma cells
    8. Franklin Disease (Heavy chain disease)
      1. M Protein
        1. Heavy chain incomplete
        2. Light chain absent

III. Findings: Polyclonal Gammopathy

  1. General
    1. Broad diffuse band
      1. Contrast with sharp spike M-Band in monoclonal
    2. Most often represents non-malignant causes
      1. Contrast with malignancy in monoclonal
  2. Causes
    1. Infection
      1. Viral Infection (HIV, Hepatitis, EBV, VZV)
      2. Endocarditis
      3. Osteomyelitis
      4. Tuberculosis
    2. Connective Tissue Disease
      1. Systemic Lupus Erythematosus
      2. Temporal Arteritis
      3. Rheumatoid Arthritis
      4. Sarcoidosis
    3. Liver disease
      1. Cirrhosis
      2. Hepatitis
      3. Primary Biliary Cirrhosis
    4. Malignancy
      1. Ovarian Cancer
      2. Lung Cancer
      3. Hepatocellular Carcinoma
      4. Renal Cancers
    5. Hematologic disorder
      1. Lymphoma
      2. Leukemia
      3. Thalassemia
      4. Sickle Cell Anemia
    6. Inflammatory condition
      1. Inflammatory Bowel Disease
      2. Cystic Fibrosis
      3. Chronic Bronchitis
    7. Thyroid disorder
      1. Grave's Disease
      2. Hashimoto's Thyroiditis

IV. Findings: Interpretation of Monoclonal Protein Spike

  1. M-Spike < 1.5 g/dl
    1. Repeat Serum Protein Electrophoresis in one year
  2. M-Spike 1.5 to 2.5 g/dl
    1. Nephelometry to quantify Immunoglobulins
    2. 24 hour urine for electrophoresis and immunofixation
  3. M-Spike >2.5 g/dl
    1. Bone survey of Humerus and femur for metastases
    2. Bone Marrow Biopsy
    3. Abdominal CT
    4. Beta-2 microglobulin level
    5. C-Reactive Protein
    6. 24 hour urine for electrophoresis and immunofixation

V. References

  1. O'Connell (2005) Am Fam Physician 71:105-12 [PubMed]
  2. Kyle (1999) Arch Pathol Lab Med 123:114-8 [PubMed]

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