Distortions but not Definitive Peaks by Capillary Serum Protein Electrophoresis Indicate Monoclonal Gammopathy of Undetermined Significance rather than Multiple Myeloma.

OBJECTIVE: Capillary electrophoresis of serum proteins demonstrates occasional distortions. Distortions or peaks in the gamma, beta, and alpha-2 zones may represent monoclonal gammopathy. In this study, we investigated if such distortions are associated with monoclonal gammopathy of undetermined significance (MGUS) or multiple myeloma. METHODS: Consecutive serum protein electrophoresis results were reviewed and immunofixation studies were recommended on specimens exhibiting distortions or distinct peaks in the gamma, beta or alpha-2 zones. RESULTS AND DISCUSSION: Of the 471 cases, we observed distortions in 101 cases. In the immunofixation studies, 17.8% of cases had a diagnosis of MGUS, but none contained multiple myeloma. CONCLUSIONS: We conclude that distortions in serum capillary electrophoresis may be associated with MGUS, but not multiple myeloma.

Overutilization of Test for Hemoglobinopathy Evaluation: Experience from a Tertiary Care Academic Medical Center.

BACKGROUND: Hemoglobin electrophoresis is a common clinical laboratory test for the identification of hemoglobinopathies in clinical practice. We investigated the utilization of this test in our academic teaching hospital and hypothesized that hemoglobin electrophoresis evaluation is overutilized at this institution. METHODS: 128 consecutive cases were analyzed and their medical records were studied to determine the clinical indication for the hemoglobin electrophoresis. RESULTS: Of the 128 cases studied, only 44% of cases had a justifiable reason for obtaining the hemoglobin electrophoresis, whereas the remaining 56% of cases did not have an acceptable indication for obtaining the test. CONCLUSIONS: We conclude that hemoglobin electrophoresis is overutilized in our academic medical center and we recommend consultation with clinical pathologists prior to ordering such tests.