II. 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. 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. 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

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Related Studies

Ontology: Paraproteinemias (C0030489)

Definition (NCI) A plasma cell disorder in which an abnormal amount of a single immunoglobulin is present in the serum. Paraproteinemias may be seen in conjunction with various carcinomas, chronic inflammatory and infectious conditions, and other diseases. --2004
Definition (MSH) A group of related diseases characterized by an unbalanced or disproportionate proliferation of immunoglobulin-producing cells, usually from a single clone. These cells frequently secrete a structurally homogeneous immunoglobulin (M-component) and/or an abnormal immunoglobulin.
Concepts Disease or Syndrome (T047)
MSH D010265
SnomedCT 278501001, 190816000, 35601003, 123061006
English Paraimmunoglobulinemia, Paraimmunoglobulinemias, Paraproteinemias, Paraproteinaemia NOS, Paraproteinemia NOS, Paraproteinemias [Disease/Finding], paraproteinemias, paraproteinemia, paraproteinaemia, Paraproteinemia NOS (disorder), Paraproteinemia (disorder), Paraproteinemia, Paraproteinaemia
Italian Paraproteinemia, Paraproteinemia NAS, Paraproteinemie
Dutch paraproteïnemie NAO, paraproteïnemie, Para-immunoglobulinemie, Paraproteïnemie, Paraproteïnemieën, Proteïnemieën, para-, Proteïnemie, para-
French Paraprotéinémie SAI, Paraprotéinémie, Paraprotéinémies
German Paraproteinaemie NNB, Paraproteinaemie, Paraimmunglobulinämien, Paraproteinämien
Portuguese Paraproteinemia NE, Paraproteinemia, Paraimunoglobulinemias, Paraproteinemias
Spanish Paraproteinemia NEOM, paraproteinemia (trastorno), paraproteinemia, SAI (trastorno), paraproteinemia, SAI, Gamapatías Monoclonales, Gammapatías Monoclonales, Gamopatías Monoclonales, paraproteinemia, Paraproteinemia, Parainmunoglobulinemias, Paraproteinemias
Japanese パラプロテイン血症NOS, パラプロテインケツショウNOS, パラプロテインケツショウ, パラプロテインケッショウ, パラプロテインケッショウNOS, 形質細胞障害, パラプロテイン血症, 異種蛋白血症, 単クローン性免疫グロブリン血症, 異常たんぱく血症, パラプロテイン血, 単クローン性ガンマグロブリン血症, パラプロテイネミア, モノクローナルガンマグロブリン血症, パラ免疫グロブリン血症, モノクローナル免疫グロブリン血症, 異常蛋白血症, M蛋白血症, 異常蛋白質血症
Swedish Paraproteinemier
Czech paraproteinémie, Paraproteinemie, Paraproteinemie NOS
Finnish Paraproteinemiat
Polish Paraproteinemie
Hungarian Paraproteinaemia k.m.n., Paraproteinaemia, Paraproteinemia
Norwegian Paraproteinemier

Ontology: Monoclonal Gammapathies (C1136085)

Definition (NCI) A laboratory test result indicating the presence of an abnormally high level of monoclonal immunoglobulins in the blood or urine.
Concepts Neoplastic Process (T191)
MSH D010265
ICD10 D47.2 , M9765/1
SnomedCT 109983007, 123061006, 134180005, 190812003, 35601003
English Gammapathy, Monoclonal, Monoclonal Gammopathies, [M] Monoclonal gammopathy, Gammopathies, Monoclonal, Gammapathies, Monoclonal, Monoclonal Gammapathy, Monoclonal Gammopathy, gammopathies monoclonal, monoclonal gammopathy, gammapathy monoclonal, monoclonal gammopathies, monoclonal gammapathies, monoclonal gammapathy, gammopathy monoclonal, [M] Monoclonal gammopathy (morphologic abnormality), Monoclonal gammopathies, Monoclonal gammopathy, Monoclonal gammopathy (clinical), Monoclonal gammopathy (disorder), gammopathy; monoclonal, monoclonal; gammopathy, Monoclonal gammopathy -RETIRED-, Monoclonal Gammapathies, Gammopathy, Monoclonal, Monoclonal gammopathy NOS
Spanish gammapatía monoclonal, Gammopatías Monoclonales, Gammopatía Monoclonal, gamopatía monoclonal (anomalía morfológica), gamopatía monoclonal, Gammapatía monoclonal, gammapatía monoclonal - RETIRADO - (concepto no activo), [M] gammapatía monoclonal, gammapatía monoclonal - RETIRADO -, [M] gammapatía monoclonal (anomalía morfológica), gammapatía monoclonal (clínica) (trastorno), gammapatía monoclonal (clínica), gammapatía monoclonal (trastorno), Gammapatía Monoclonal
Portuguese Gamopatia Monoclonal, Gamopatia monoclonal, Gamapatia Monoclonal, Gamopatias Monoclonais
French Gammapathie monoclonale, Gammopathie monoclonale, Gammapathies monoclonales
German Gammopathie, monoklonale, Monoklonale Gammopathie, monoklonale Gammopathie, Monoklonale Gammopathien
Korean 단클론성 감마병증
Dutch monoclonale gammopathie, gammopathie; monoclonaal, monoclonaal; gammopathie, Monoclonale gammopathie, Monoklonale gammopathie, Gammopathie, monoklonaal
Italian Gammopatia monoclonale
Japanese タンクローンセイメンエキグロブリンケッショウ, 単クローン性免疫グロブリン血症, タンクローンセイメンエキグロブリンケツショウ
Czech Monoklonální gamapatie, monoklonální gamapatie, gamopatie monoklonální
Hungarian Monoclonalis gammopathia
Norwegian Monoklonal gammopati, Monoklonal gammopati med usikker signifikans, MGUS