Journal of Clinical Chemistry and Laboratory Medicine
Open Access
ISSN: 2736-6588
ISSN: 2736-6588
Penn Muluhngwi*, Tyler Yin, Karen M. Cost and Ronald J. Elin
Background: Monoclonal Immunoglobulins (MIs) are screened using Serum Protein Electrophoresis (SPE) and Capillary Zone Electrophoresis (CZE). In SPE, proteins are separated in an agarose gel by their electrophoretic mobility and charge distribution. MIs are present in the gamma globulin region, but can also be found in the beta or alpha-2 region, which can make quantitation and interpretation inaccurate. Elevated beta globulin may be an indication of iron deficiency anemia, 3rd trimester pregnancy or oral contraceptive use. CZE resolves the betaglobulin as two peaks; beta-1 (transferrin) and beta-2 (complement proteins (C3)) regions. We present six cases that illustrate the resolving power of 6-band CZE vs. 5-band SPE to detect IgA and IgM MI bands hidden within the beta region.
Methods: SPE and CZE were performed using the Helena SPIFE 3000 and sebia capillarys 2 systems respectively. Confirmation of MIs was by Immunofixation Electrophoresis (IFE).
Results: For all patients, SPE reported a wide range in electrophoretic pattern and MI detection. CZE was able to identify M-proteins not quantitated on SPE. We observe a pattern whereby the concentration difference between beta-1 and beta-2 become reversed (“flipped”) in the presence of a hidden IgA MI by SPE.
Conclusion: Six-band CZE is superior to 5-band SPE due to its ability to separate the beta region into beta-1 and beta-2, thus allowing better detection of hidden MIs. Further studies with a larger sample size may be warranted to establish a rule for IFE reflexing when the beta-2 fraction is greater than the beta-1 by the CZE method.
Published Date: 2024-09-28; Received Date: 2020-03-24