dysproteinemia


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  • Clinical suspician

    • CRAB: calcium, renal, anemia, bone
    • high or low IgG
    • BJ proteinuria
    • high total protein
    • serum viscosity if IgM > 4 g/dL or IgA/G > 6 g/dL

  • Testing

    • screen & quantify: SPEP, UPEP and FLC
      • FLC better at light chains
      • UPEP catches excreted light chains
      • FLC nml K/L ratio: 0.26-1.65
    • add DME to breakup dimers/polymers if broad band
    • confirm with IFE if
      • extra bands
      • low gamma
      • prior MM dx
      • heavy chain disease
      • high clinical suspician
    • myeloma workup if monoclonal or biclonal
    • other patterns
      • polyclonal: reaction, infection, inflammation
      • bisalbuminemia: rare familial
      • alpha
        • alpha1: alpha1 antitrypsin, certain lipoproteins
        • alpha1, 2: acute phase reactant
        • alpha2: hemolysis -> haptoglobin complex
      • beta and gamma
        • iron deficiency -> transferrin -> beta band
        • fibrinogen: band between beta and gamma, goes away with thrombin
        • liver disease: beta-gamma bridge
      • nephrotic syndrome -> decr albumin and gamma, but incr alpha2 and beta

  • Ddx

    • PCN
    • LPL (Waldenstrom)
    • CLL (low level M protein)
    • HCD (heavy chain disease)
    • MIDD (monoclonal immunoglobulin deposition disease)
    • MGUS
    • autoimmune
    • acquired Abs
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