More than just quality control.

Providing quality flow cytometric results requires more than monitoring quality control data. Laboratories should standardize all aspects of testing and evaluate each one critically for opportunities to improve. This article discusses a complete quality management system that includes assay validation and change control, specimen collection and delivery, ordering of flow cytometric testing, sample preparation, verification of specimen integrity, flow cytometry data acquisition, analysis and interpretation, reporting of results, document of standard operating procedures, proficiency testing, training, and documentation of ongoing competency.

Low IgE monoclonal gammopathy level in serum highlights 20-yr survival in a case of IgE multiple myeloma.

This report describes the diagnosis, follow-up, and problems measuring serum immunoglobulin E (IgE) levels in a case of IgE myeloma with 20-yr survival. Serum and urine protein electrophoresis, immunofixation, and the N Latex IgE test were used to characterize the monoclonal proteins. The diagnosis of multiple myeloma in a 56-yr-old man was based on 5.4 g/24 h of monoclonal free lambda chain in urine and bone marrow findings of 23.5% plasma cells (19% mature and 4.5% atypical). IgE lambda monoclonal protein in serum measured 506,000 microg/L (210 833 IU/mL). The lack of other clinical findings of multiple myeloma places this case in the category of 'smoldering or indolent myeloma'. Measurement of serum IgE levels was complicated by the need to predilute serum to avoid antigen excess. Following chemotherapy, the patient went into clinical remission, eventually dying of complications of emphysema. This case expands the recognized clinical spectrum of IgE multiple myeloma.