A study to Evaluate Immunoglobulin’s fraction by Serum Protein Electrophoresis for occurrence of Multiple Myeloma in a Tertiary Care Hospital.

Rashni B J, Bhutesh Kumar Sharma, Sultana Furruqh

Abstract


Background: Serum protein electrophoresis (SPE) is a diagnostic laboratory test that separates and quantifies several classes of serum proteins and that identifies and characterizes the monoclonal gammopathies (M-protein).

Aims and Objective:This study was taken up with an aim to evaluate the relevance and significance of immunoglobulin fraction in discerning multiple myeloma and to assess the morbidity of cases in relation to its clinical diagnosis.

Materials and Method:This study was carried out by analysing data with gamma globulins above biological reference range (0.6-1.6gm/dL) from the samples requested for serum protein electrophoresis by cellulose acetate method during Sept 2013 to Aug 2014 in St. John’s medical college biochemistry lab, Bengaluru (Total of 95 cases). Densitometrically estimated M proteins were further divided into 2 groups of below and above 3gm/dL according to the IMWG criteria for classification of Multiple myeloma.

Result: Out of 95 cases, 55(57.9 %) were above 3gm/dL and the remaining 40(42.1%) were below 3gm/dL. Among those 95 cases 18 were confirmed with multiple myeloma. 13 out of 18 cases fall among the group where gamma globulin is > 3g/dL with 81% of them having gamma above 4g/dL. Five cases of multiple myeloma had also been confirmed with their gamma globulins falling below 3g/dL which is compelling.

Conclusion:The significance of elevated gamma globulins value less than the prescribed criteria of IMWG for diagnosing Multiple myeloma gave us importance of clinical correlation before releasing report. Though the morbidity percentage (20%) of multiple myeloma among the group with gamma globulins less than 3gm/dL, is less but nevertheless significant.More number of studies with large sample numbers is required to understand the cases of multiple myeloma with their gamma globulins falling below the IMWG criteria cut off limit.


Keywords


Serum protein Electrophoresis; SPE; M band; Multiple Myeloma

Full Text:

PDF

References


. International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003; 121(5): 749-757.

. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2009; 23(1):3-9.

. Keren, D.F., Alexanian, R., Goeken, J.A., Gorevic, P.D., Kyle, R.A. & Tomar, R.H. Guidelines for clinical and laboratory evaluation of patients with monoclonal gammopathies. Archives of Pathology and Laboratory Medicine 1999; 123: 106–107.

. Moreau P, San Miguel J, Ludwig H, et al. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24: Suppl 6: vi133-vi137.

. Bird, Jennifer M., et al. "Guidelines for the diagnosis and management of multiple myeloma 2011."British Journal of Haematology 2011; 154 (1): 32-75.

. Kyle RA. Multiple Myeloma: An overview in 1996. The Oncologist 1996; 1:315-23.

. Multiple myeloma: Review of 869 cases: Robert A. Kyle, Mayo Clinic Processing.

. Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003; 78(1):21-33.

. Kyle RA. Multiple myeloma: an odyssey of discovery. Br J Haematol. 2000; 111:10351044.

. What Is Multiple Myeloma? Atlanta: American Cancer society. 2013

. American Cancer Society. Cancer Facts and Figures 2013. Atlanta, GA: American Cancer Society; 2013

. Reviewed Facts spring 2014: Leukaemia and Lymphoma society. 2014:17-18.

. Dimopoulos M, Kyle R, Fermand JP, et al. Consensus recommendations for standard investigative workup: report of the International Myeloma. Workshop Consensus Panel 3. Blood. 2011; 117:4701-4705.

. O’Connell TX, Horita TJ, Kasravi B. Understanding and interpreting serum protein electrophoresis. Am Fam Physician. 2005 Jan; 1 (1):105-12.

. Attaelmannan M, Levinson SS. Understanding and identifying monoclonal gammopathies. Clin Chem 2000; 46:1230–8.

. Tripathy S. The Role of Serum Protein Electrophoresis in the Detection of Multiple Myeloma: An Experience of a Corporate Hospital. Journal of Clinical and Diagnostic Research: JCDR 2012; 6(9):1458-1461.

. Chopra Gs, Gupta PK, Mishra DK. The evaluation of suspected monoclonal gammopathies: the experience in a tertiary care hospital. MJAFI. 2006; 62; 134-37.

. Vavricka SR, Burri E, Beglinger C, Degan L. Serum protein Electrophoresis: An underused but very useful test. Digestion. 2009; 79: 203-10.

. Robert A. Kyle, Sequence of Testing for Monoclonal Gammopathies. Archives of Pathology & Laboratory Medicine: February 1999; 123 (2): 114-118.

. Singh, Kalpana, et al. "Immunological evidence of monoclonal gammopathy in north India: a hospital based study." Pathology and Laboratory Medicine International 2010; 2: 107–111.

. San-Miguel JF, Paiva B, Gutierrez NC. Am Soc Clin Oncol Educ Book. New tools for diagnosis and monitoring of multiple myeloma. 2013: 33.e313.

. Interlab S.R.L: Serum Protein Electrophoresis user guide.

. David F Keren. Protein Electrophoresis in Clinical Diagnosis. 2003

. Daisuke Katagiri, Eisei Noiri, and Fumihiko Hinoshita, “Multiple Myeloma and Kidney Disease,” The Scientific World Journal, 2013, 487285, 9, 2013. doi:10.1155/2013/487285

. Silvestris F, Cafforio P, Tucci M, Dammacco F. Negative regulation of erythroblast maturation by Fas L(+)/TRIAL(+) highly malignant plasma cells: a major pathogenetic mechanism of anemia in multiple myeloma. Blood. 2002; 99:1305-1313.

. Healy CF, Murray JG, Eustace SJ, Madewell J, O’Gorman PJ, O’Sullivan P. Multiple myeloma: a review of imaging features and radiological techniques. Bone Marrow Res 2011; 2011:583439.

. Patolia, Setu, et al. "Multiple myeloma with Mixed Lytic and blastic bone lesions with Lymphadenopathy: Rare manifestation of a common disease-case presentation and literature review." World Journal of Oncology 2012; 3 (2): 78-82.

. Durie, Brian GM, and Sydney E. Salmon. "A clinical staging system for multiple myeloma Correlation of measured myeloma cell mass with presenting." Cancer 1975; 36: 842-854.

. Greipp, Philip R., et al. "International staging system for multiple myeloma." Journal of Clinical Oncology 2005; 23 (15): 3412-3420.

. Cook, Lucy, and Donald HC Macdonald. "Management of paraproteinemia." Postgraduate Medical Journal 2007; 83 (978): 217-223.

. Gupta, Meenakshi, Rana Arun Gopal Krishan Pal, and Deepika Tikoo. "Multiple myeloma: the disease and its treatment." International Journal of Basic & Clinical Pharmacology 2013; 2 (2): 103-121.

. Alexander DD, Mink PJ, Adami HO, et al. Multiple myeloma: a review of the epidemiologic literature. Int J Cancer 2007; 120: 40–61.

. Anna Dmoszyńska. Review article: Diagnosis and the current trends in multiple myeloma therapy.

. Caers, Jo, et al. "Multiple myeloma–an update on diagnosis and treatment." European Journal of Haematology 2008; 81 (5): 329-343.

. Kumar, Lalit, P. Vikram, and V. Kochupillai. "Recent advances in the management of multiple myeloma." National Medical Journal of India 2006; 19 (2): 80.




DOI: http://dx.doi.org/10.7439/ijbr.v8i7.4239

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.




Copyright (c) 2017 International Journal of Biomedical Research

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.