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Serum Protein Electrophoresis AbnormalityAka: Monoclonal Gammopathy, M-Spike, Paraproteinemia, Polyclonal Gammopathy

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  1. See Also
    1. Serum Protein Electrophoresis (SPEP)
  2. Monoclonal Gammopathy (M-Spike)
    1. General
      1. Paraprotein peak present (Paraproteinemia)
      2. Associated with malignancy
      3. Sharp spike M-Band
        1. Contrast with broad polyclonal band (see below)
    2. Causes
      1. Multiple Myeloma
        1. Narrow M-Protein spike >3 g/dl
        2. Lytic skeletal lesions, Pancytopenia, Renal Failure
      2. Monoclonal Gammopathy of Undetermined Significance (MGUS)
      3. Benign paraproteinemia (essential paraproteinemia)
      4. Waldenstrom Macroglobulinemia
        1. M Protein: IgM
        2. Hyperviscosity and hypercellular Bone Marrow
      5. Plasmacytoma
      6. Amyloidosis
      7. Plasma cell Leukemia
        1. M-Protein: Low levels
        2. Peripheral blood with >20% plasma cells
      8. Franklin Disease (Heavy chain disease)
        1. M Protein
          1. Heavy chain incomplete
          2. Light chain absent
  3. Polyclonal Gammopathy
    1. General
      1. Broad diffuse band
        1. Contrast with sharp spike M-Band in monoclonal
      2. Most often represents non-malignant causes
        1. Contrast with malignancy in monoclonal
    2. Causes
      1. Infection
        1. Viral infection (HIV, Hepatitis, EBV, VZV)
        2. Endocarditis
        3. Osteomyelitis
        4. Tuberculosis
      2. Connective tissue disease
        1. Systemic Lupus Erythematosus
        2. Temporal Arteritis
        3. Rheumatoid Arthritis
        4. Sarcoidosis
      3. Liver disease
        1. Cirrhosis
        2. Hepatitis
        3. Primary biliary Cirrhosis
      4. Malignancy
        1. Ovarian Cancer
        2. Lung Cancer
        3. Hepatocellular Carcinoma
        4. Renal cancers
      5. Hematologic disorder
        1. Lymphoma
        2. Leukemia
        3. Thalassemia
        4. Sickle Cell Anemia
      6. Inflammatory condition
        1. Inflammatory Bowel Disease
        2. Cystic Fibrosis
        3. Chronic Bronchitis
      7. Thyroid disorder
        1. Grave's Disease
        2. Hashimoto's Thyroiditis
  4. Interpretation of Monoclonal Protein Spike
    1. M-Spike < 1.5 g/dl
      1. Repeat Serum Protein Electrophoresis in one year
    2. M-Spike 1.5 to 2.5 g/dl
      1. Nephelometry to quantify Immunoglobulins
      2. 24 hour urine for electrophoresis and immunofixation
    3. M-Spike >2.5 g/dl
      1. Bone survey of humerus and femur for metastases
      2. Bone Marrow Biopsy
      3. Abdominal CT
      4. Beta-2 microglobulin level
      5. C-Reactive Protein
      6. 24 hour urine for electrophoresis and immunofixation
  5. References
    1. O'Connell (2005) Am Fam Physician 71:105
    2. Kyle (1999) Arch Pathol Lab Med 123:114

Paraproteinemias (C0030489)

Definition (MSH)A group of related diseases characterized by an unbalanced or disproportionate proliferation of immunoglobulin-producing cells, usually from a single clone. These cells frequently secrete a structurally homogeneous immunoglobulin (M-component) and/or an abnormal immunoglobulin.
Definition (NCI)A plasma cell disorder in which an abnormal amount of a single immunoglobulin is present in the serum. Paraproteinemias may be seen in conjunction with various carcinomas, chronic inflammatory and infectious conditions, and other diseases. --2004
ConceptsDisease or Syndrome (T047)
MSHD010265
EnglishParaimmunoglobulinemia, Paraimmunoglobulinemias, Paraproteinaemia, Paraproteinemia, Paraproteinemias
Spanishparaproteinemia
Parent ConceptsDisorder of plasma protein metabolism NOS (C0154253), Blood Protein Disorders (C0005830), Immunoproliferative Disorders (C0021070), Abnormal Blood Chemistry and Hematology Test Result (C1332129), Other paraproteinemias (C0029698), Ambiguous concept (C1274012)
SourcesAOD, CSP, LCH, MSH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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