Utility of Immunofixation as a Follow-up to Select Abnormal Serum Protein Electrophoresis Patterns and Suggestions for Clinical Correlation

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Figure 1.
Normal serum protein electrophoresis pattern 4. Reprinted from Advances in Clinical Chemistry, volume 42, Xavier Bossuyt, “Advances in serum protein electrophoresis,” pages 43–80, copyright (2006), with permission from Elsevier.
Download figure
Open in new tab
Download powerpoint
Figure 2.
Arrow indicates a clear fibrinogen band present in this patient sample.
Download figure
Open in new tab
Download powerpoint
Figure 3.
(A) Initial SPE pattern with apparent beta zone abnormality. (B) Follow-up IFE identifying band as IgA kappa. Abbreviations: IFE, immunofixation electrophoresis; SPE, serum protein electrophoresis.

Table 1.

IFE results for selected SPE patterns of interest

SPE Pattern	Follow-up Immunofixations Performed	Positive^*	Negative	Total Patterns Observed
Acute phase-like reaction	13	2 (15%)	11	21
Fibrinogen band present	1	0 (0%)	1	1
Beta zone abnormalities	4	4 (100%)	0	4
Polyclonal hypergammaglobulinemia	8	3 (38%)	5	14
Hypogammaglobulinemia	17	13 (76%)	4	17

↵* Percentage based on the number of positives from samples with follow-up immunofixation performed, rounded to nearest whole number.Abbreviations: IFE, immunofixation electrophoresis; SPE, serum protein electrophoresis.

Table 2.

Summary of recommendations for follow-up of select SPE patterns

SPE Pattern	Pattern Description	Recommendation for Follow-up
Acute phase reaction	Decreased albumin with elevated α-1 and α-2 globulins Possible CRP present as faint band in midgamma region	Correlate with patient’s diagnoses and other laboratory studies IFE rarely indicated
Fibrinogen band present	Clear band in fast gamma region	Pretreat sample with 10% ethanol or thrombin Correlate with patient’s medication list and/or coagulation studies IFE should be performed
Beta zone abnormalities	Atypical zones of restriction (spikes) in beta region Blurring of the beta-gamma region borders	Review patient’s history and consider additional testing IFE should be performed
Polyclonal gammopathy	Broad, diffuse banding in gamma region	Correlate with patient’s diagnoses and other laboratory studies IFE may be indicated
Hypogammaglobulinemia	Markedly decreased gamma globulins (flattening of gamma region line) Possible elevation of α-2 globulin, α-2 to α-1 ratio, or low concentration monoclonal spikes in otherwise normal patterns	Consider urine SPE/IFE with urinalysis Review prior SPE patterns and medication lists for patients with previously documented treatment-related bands IFE should be performed