serum protein electrophoresis

application point

between beta and gamma

hemolysis

“bridging” between alpha 2 and beta

fibrinogen (plasma)

between beta and gamma

complement

spike in beta region (beta 2 in split beta)

CRP

gamma region closer to application point

bisalbuminemia

• 2 albumin peaks

• increased alpha 1

acute phase reaction

• decreased albumin

• increased alpha 1 and alpha 2

nephrotic syndrome

• decreased albumin

• elevated alpha 2

polyclonal hypergammaglobulinemia

elevation of all abs

severe hepatic disease (polyclonal gammopathy)

• decreased albumin, alpha 1, alpha 2, and beta

• increased gamma

anti-trypsin deficiency

• decreased alpha 1

beta-gamma bridge

• decreased albumin

• beta gamma bridge (IgA and IgG increase)

MGUS

• smaller spike in the beta region less than 3 g/dL

• no supression of gamma

immunofixation electrophoresis

tells us exactly what is causing the spike

CRAB

calcium, renal dysfunction, anemia, bone deformities

multiple myeloma

• monoclonal spike greater than 3 g/dL

• free light chains in urine

• 60:40 kappa/lambda

difficulties in diagnosing multiple myeloma

• prozone- dilute sample

• IgD and IgE not used for immunofixation techniques

• therapy with monoclonal abs (IgG) can cause false spike

how do you correct a false IgG spike?

doing immunosubtraction

CSF electrophoresis

• used to diagnose multiple sclerosis

• compare urine to CSF

• oligoclonal banding= multiple sclerosis