Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter February 22, 2014

Combined light chain immunofixation to detect monoclonal gammopathy: a comparison to standard electrophoresis in serum and urine

  • Wessel Jenner , Sandra Klingberg , Jill R. Tate , Urs Wilgen , Jacobus P.J. Ungerer and Carel J. Pretorius EMAIL logo

Abstract

Background: The purpose of this study was to evaluate a combined κ and λ light chain immunofixation (CLIF) as a screening tool to detect monoclonal immunoglobulins in serum and urine. A secondary aim was to investigate the impact on workflow and reagent utilisation of a systematic implementation of CLIF in addition to routine protein electrophoresis (PE) on all samples.

Methods: Light chain antisera (κ and λ) were mixed in a 1:1 ratio and loaded in the same sequence as the PE to create a superimposable image.

Results: The CLIF procedure agreed significantly better with standard immunofixation procedures in the serum and urine. In 33 (22%) new patients and in 114 (15%) follow-up patients CLIF detected a band missed by PE in serum. In 34 (4.5%) of previously categorised cases the monoclonal band was below the detection limit of CLIF in serum, but still detectable by conventional immunofixation electrophoresis. In one case (0.7%) a band in a urine specimen was missed by CLIF compared to 70 (49%) missed by PE. After the systematic introduction of CLIF turn-around-times (TATs) and utilisation of laboratory consumables decreased significantly (p<0.001).

Conclusions: A systematic implementation of CLIF led to the detection of monoclonal bands missed by PE with an improvement in TATs and a decrease in cost.


Corresponding author: Carel J. Pretorius, Department of Chemical Pathology, Block 7, Floor 3, Herston Hospitals Campus, Herston, 4029, QLD, Australia, Phone: +617 36460083, Fax: +617 36461392, E-mail:

Acknowledgments

We thank Rehna Gous, Elzahn de Waal, Katie Buzacott, Matt Burke, Izabela Valentine, Nick Avsenev, Anfernee Tseng, Bozena Gluchowska and Linden Callaghan for technical support and data collection.

Conflict of interest statement

Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

References

1. Dimopoulos M, Kyle R, Fermand J, Rajkumar SV, San Miguel J, Chanan-Khan A, et al. on behalf of the International Myeloma Workshop Consensus Panel 3.Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3. Blood 2011;117:4701–5.10.1182/blood-2010-10-299529Search in Google Scholar PubMed

2. Tate JR, Caldwell G, Daly J, Gillis D, Jenkins M, Jovanovich S, et al. on behalf of the working party on standardised reporting of protein electrophoresis. Recommendations for standardized reporting of protein electrophoresis in Australia and New Zealand. Ann Clin Biochem 2012;49:242–56.10.1258/acb.2011.011158Search in Google Scholar PubMed

3. Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA, et al. Screening panels for detection of monoclonal gammopathies. Clin Chem 2009;55:1517–22.10.1373/clinchem.2009.126664Search in Google Scholar PubMed PubMed Central

4. Fulton RB, Fernando SL. Serum free light chain reduces the need for serum and urine immunofixation electrophoresis in the evaluation of monoclonal gammopathy. Ann Clin Biochem 2009;46:407–12.10.1258/acb.2009.009038Search in Google Scholar PubMed

5. Wadhera RK, Rajkumar V. Prevalence of monoclonal gammopathy of undetermined significance: a systemic review. Mayo Clin Proc 2010;85:933–42.10.4065/mcp.2010.0337Search in Google Scholar PubMed PubMed Central

6. Kyle RA, Therneau TM, Rajkumar V, Larson MS, Plevak MF, Offord JR, et al. Prevalence of monoclonal gammopathy of undertermined significance. N Engl J Med 2006;354:1362–9.10.1056/NEJMoa054494Search in Google Scholar PubMed

7. Eisele L, Dürig J, Hüttmann A, Dührsen U, Assert R, Bokhof B, et al. on behalf of the Heinz Nixdorf Recall study investigative group. Prevalence and progression of monoclonal gammopathy of undetermined significance and light-chain MGUS in Germany. Ann Hematol 2012;91:243–8.10.1007/s00277-011-1293-1Search in Google Scholar PubMed

8. Altman DG, Machin D, Bryant TN, Gardner MJ. Statistics with confidence. 2nd ed. London: BMJ Books, 2000.Search in Google Scholar

9. Rang M. The Ulysses syndrome. Can Med Assoc J 1972;106:122–3.Search in Google Scholar

Received: 2014-1-6
Accepted: 2014-1-28
Published Online: 2014-2-22
Published in Print: 2014-7-1

©2014 by Walter de Gruyter Berlin/Boston

Downloaded on 5.3.2024 from https://www.degruyter.com/document/doi/10.1515/cclm-2014-0023/html
Scroll to top button