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 |
Abbreviations: CRP, C-reactive protein; IFE, immunofixation electrophoresis; SPE, serum protein electrophoresis.