I agree with these thoughts except to say that serum
immunoglobulins ONLY, as a first line investigation
for possible monoclonal gammopathy, is not reliable.
Paraproteins do not always react in the same way as
'normal' immunoglobulins (particularly monoclonal IgA
and IgM) and it is possible to have measured
immunoglobulins within the reference range in the
presence of a paraprotein.
Our protocol is to do serum AND urine electrophoresis
as first line tests for paraprotein screening, and
serum immunoglobulins as a specific request (usually
for suspected immunodeficiency) or as follow up to a
newly identified paraprotein, to assess the degree of
immune paresis.
I am interested to know how you (and others) measure
and monitor paraprotein concentration in individual
patients.
Regards,
Stuart Robertson,
Biochemistry Dept,
Hull Royal Infirmary
HU3 2JZ
UK
--- "Gerald. Maguire" <[log in to unmask]> wrote:
> Edward Kearney asks "Would it not be better to
> perform electrophoresis and
> then measure immunoglobulins if indicated?"
>
> I don't think so.
> I believe it would be foolish for instance to try to
> investigate possible
> immunodeficiency on the basis of an electrophoretic
> strip.
> Also the measurement of immunoglobulins by specific
> methods may be cheaper
> overall (being more readily automatable and less
> operator dependent), more
> accurate and more precise than the performing of an
> electrophoretic strip.
>
> Edward kearney asks "Is there any value to measuring
> Ig's in a patient with
> a polyclonal gammaglobulin increase ?"
>
> The answer is yes in some circumstances. For
> instance the level can give a
> clue to the disease (eg in Sjogren's and HIV). Also
> the class can give a
> clue to the disease (eg in PBC). Furthermore it is
> not always easy to
> detect, by electrophoresis, a polyclonal increase in
> IgM or IgA.
>
> I DO NOT believe that electrophoresis should be used
> for non-specific
> screening. It should be used to investigate
> suspected myeloma.
> If other conditions are suspected then specific
> tests should be performed.
> eg Igs, AAT, caeruloplasmin etc.
> In these circumstances, the electrophoresis adds
> nothing and may be
> misleading.
>
> Gerald A Maguire
> Dept of Clinical Biochemistry and Clinical
> Immunology
> Addenbrooke's Hospital
> Cambridge
> UK
> CB2 2QR
> UK
> Tel 44 (0) 1223 217159
> fax 44 (0) 1223 216862
>
>
> ----------
>
>
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