An unusual pattern in serum protein electrophoresis to take in mind: A case report.

Here we described a case of an asymptomatic 73 years-old female patient in geriatric routine consultation, whose laboratory testing showed hyperproteinemia with accompanying hyperglobulinemia. A diagnosis of BGUS was made only after a correlation among SPEP, densitometry tracing and IFE results was established, evidencing a second peak, that was less evident and not reported at first. These biclonal conditions are of very low incidence in the clinical laboratory, requiring the laboratory professional to have particular skills for their identification. As far as is known, clinical findings in BGUS are similar to those found in MGUS. However, they remain not well understood. Therefore, for an accurate diagnosis of BGUS, the clinical laboratory technician must be trained and sensitized to detect a second M - protein as a band or peak; taking in mind the possible different scenarios in heavy and light chain typing.

Se describe el caso de paciente asintomática de 73 años de edad en consulta geriátrica de rutina, cuyos estudios de laboratorios muestran hiperproteinemia acompañada de hiperglobulinemia. Se estableció el diagnóstico de GBSI después de correlacionar entre resultados de electroforesis de proteínas, trazo de densitometría e inmunofijación en suero, los cuales evidenciaron un segundo pico monoclonal menos evidente y no reportado de primera instancia. Este tipo de condiciones biclonales son de muy baja incidencia en laboratorio clínico, lo cual requiere que profesional de laboratorio tenga ciertas habilidades para su identificación. Hasta donde se conoce, los hallazgos clínicos de GBSI son similares a aquellos encontrados en GMSI. Sin embargo, continúan sin ser bien comprendidas. Por tanto, a fin de un diagnóstico más preciso, el técnico de laboratorio debe estar entrenado y sensibilizado para encontrar una segunda proteína M como banda o pico, tomando en cuenta los diferentes posibles escenarios en la tipificación de cadenas pesadas y ligeras.

Multiple Myeloma: The Case of the Disappearing Band.

This case study presents a patient with multiple myeloma whose serum specimen exhibits 2 distinct bands in serum protein electrophoresis but only one band in immunofixation electrophoresis. This latter, single band corresponds to the M-spike. An investigation is presented to determine the identity of this disappearing or phantom band. Furthermore, this case is used as a teaching point to explain the criteria used for staging multiple myeloma, how a cell can become a myeloma propagating cell, methods that can be used to identify unexpected bands in serum protein electrophoresis, possible explanations for bands in the beta region, the usual treatment regimens in multiple myeloma and finally specimen collecting and handling procedures for serum protein electrophoresis.

Comparison between immunofixation and electrophoresis for the early detection of relapsed multiple myeloma / Comparação entre imunofixação e eletroforese na detecção precoce de recidivas do mieloma múltiplo

ABSTRACT Introduction: Multiple myeloma (MM) is an incurable progressive hematological neoplasia characterized by heterogeneous evolution and by relapses after therapy. Objective: Compare the effectiveness of serum immunofixation (SIF) and electrophoresis (SPE) techniques in the detection of relapses in MM patients undergoing treatment at the University Hospital of Santa Maria (HUSM). Material and methods: The study was conducted from January 2012 to July 2014 and included 52 patients from HUSM with confirmed diagnosis of MM. The retrospective monitoring based on laboratory analyses indicated that nine of these patients relapsed, in whom it was possible to compare the effectiveness of SIF and SPE techniques for detecting relapses. Results: For the nine patients, SIF always detected MM relapses earlier than SPE, with a precocity ranging from 2.0 to 18.8 months, for an average of 6.6 months. Discussion and conclusion: The results indicated that SIF was more effective than SPE for the early detection of relapses, regardless of the class and type of M component (mono/biclonal). Therefore, the use of SIF allows for better monitoring of MM patients, especially for the detection of relapses, thereby helping in choosing the most appropriate therapy and resulting in increased duration of survival period free of disease.

RESUMO Introdução: O mieloma múltiplo (MM) é uma neoplasia hematológica progressiva e incurável, caracterizada pela evolução heterogênea e pela ocorrência de recidivas nos pacientes após o tratamento. Objetivo: Comparar as técnicas de imunofixação (IFS) e eletroforese (EFS) séricas quanto à eficácia em detectar precocemente as recidivas em pacientes com MM e em tratamento junto ao Hospital Universitário de Santa Maria (HUSM). Material e métodos: O estudo foi realizado no período de janeiro de 2012 a julho de 2014, sendo incluídos 52 pacientes do HUSM com diagnóstico confirmado de MM. O monitoramento retrospectivo, realizado por meio de análises laboratoriais, indicou que nove desses pacientes recidivaram, nos quais foi possível comparar a eficácia das técnicas de IFS e EFS na detecção de tais recidivas. Resultados: Nos nove pacientes em estudo, a IFS sempre detectou as recidivas do MM antes da EFS, sendo que essa precocidade variou de dois a 18,8 meses, com tempo médio de 6,6 meses. Discussão e conclusão: Os resultados indicaram que a IFS foi mais eficaz do que a EFS em detectar as recidivas, independentemente da classe e do tipo de componente M (mono/biclonal). Portanto, o uso da IFS permite monitorar melhor os pacientes com MM, principalmente na detecção das recidivas, o que pode auxiliar na escolha da terapia mais adequada, além de aumentar o tempo de sobrevida livre da doença.

Testes laboratoriais para avaliação do componente monoclonal / Laboratory tests for evaluating the M-component

As gamopatias monoclonais resultam de hiperprodução de um único clone anormal de células plasmocitárias ou linfócitos B. O objetivo da avaliação laboratorial nas gamopatias é demonstrar a presença, a quantidade e o tipo de proteína anormal presente no soro e/ou na urina através do estudo do perfil protéico, quantificação das imunoglobulinas e cadeias leves e avaliação da proteinúria. Este artigo descreve as principais técnicas laboratoriais disponíveis, bem como suas indicações e limitações.

Monoclonal gammopathies result from an overproduction of a single abnormal clone of a plasma cell or B lymphocyte. The purpose of the laboratory protocols in these situations is to demonstrate the presence, the characterization and the concentration of an abnormal protein detected in serum and/or urine samples. The laboratory investigation is based on the electrophoretic protein profile, quantification of immunoglobulins, free light chains and proteinuria. This paper describes the major available laboratory methods as well their indications and limitations.