Summary:
Background: Multiple Myeloma (MM) is a neoplasm of B
cell lineage characterized by excessive proliferation of
abnormal plasma cells, secreting abnormal
immunoglobulin causing monoclonal gammopathy which
can be detected by the presence of M protein in serum and
urine electrophoresis.
Aim: Present study is aimed to detect and quantify
monoclonal gamma globulins by SPEP and IFE in
suspected case of MM and other plasma cell dyscrasias
and also to find out the discrepant findings between SPEP
and IFE.
Methods: A retrospective observational study was carried
out on clinically highly suspected cases of Multiple Myeloma
(MM) presenting with backache, asthenia and generalized
weakness at Armed forces Institute of Pathology(AFIP),
Dhaka cantonment from January 2015 to July 2016. A
total of 140 blood samples were collected and subjected to
serum protein electrophoresis (SPEP) and Immunofixation
electrophoresis (IFE). IFE identifies the type of heavy (IgG,
IgM or IgA) and light chain (either kappa or lambda in
suspected cases of MM
Results: Out of 140 cases, SPEP identified monoclonal band
in 62 cases and either non-specific findings or polyclonal
band in 78 cases. At the same time immunofixation
electrophoresis (IFE) which was done on all samples
detected another 14 cases of M-band in addition to earlier
62 cases of monoclonal gammopathy by SPEP. Among
140 cases, SPEP detected M-band in 62 cases, whereas
IFE identified monoclonal band in 76 cases. So in the
remaining 14 cases (10%) small sharp spikes of monoclonal
band was found only by IFE whereas SPEP failed to detect
those 14 cases.
Conclusion: SPEP is an easy to perform laboratory test
which can be used for detection and quantification of
monoclonal gammopathy but there is some limitation in
detecting monoclonal band by SPEP. IFE is more sensitive
to detect the monoclonal band than SPEP. So both SPEP
and IFE should be done simultaneously for precise
diagnosis of MM and related disorders.
Keywords: Multiple Myeloma, Bone marrow, Serum Protein
Electrophoresis, Immunofixation electrophoresis.
(J Bangladesh Coll Phys Surg 2018; 36: 95-100)
DOI: http://dx.doi.org/10.3329/jbcps.v36i2.36076