Sequence of testing for monoclonal gammopathies.
The first test for recognition of monoclonal gammopathies should be serum protein electrophoresis with high-resolution agarose gel. Serum protein electrophoresis should be performed whenever multiple myeloma, Waldenström's macroglobulinemia, primary amyloidosis, or a related disorder is suspected. Immunofixation is critical for the differentiation of a monoclonal from a polyclonal increase in immunoglobulins. Quantitation of immunoglobulins should be performed with a rate nephelometer. The viscosity of serum should be measured if the patient has signs or symptoms of hyperviscosity syndrome. A 24-hour urine specimen should be obtained for determination of the total amount of protein excreted each day. Immunofixation of the urine should be performed on every patient who has an M-protein level greater than 1.5 g/dL (15 g/L) in the serum or in whom multiple myeloma, Waldenström's macroglobulinemia, primary amyloidosis, or a related disorder is suspected.
Division of Hematology and Internal Medicine, Mayo Medical School, Mayo Clinic and Mayo Foundation, Rochester, Minn, USA.
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Kyle
D004586:Electrophoresis / Q000379:methods*; D006801:Humans; D007122:Immunoelectrophoresis / Q000379:methods*; D007755:Laboratories, Hospital / Q000592:standards*; D010265:Paraproteinemias / Q000097:blood* / Q000652:urine*