Version May 2024
| Studies on serum | |
| Total serum protein | An elevated total serum protein level does not distinguish among the type of protein that is elevated (ie, albumin, immunoglobulin, other) and cannot differentiate a monoclonal from a polyclonal increase. |
| Serum protein electrophoresis (SPEP) | SPEP uses electrophoresis to separate serum proteins and allows for the detection and quantification of a monoclonal protein (M-protein) in the blood. Once detected, the clonality must be confirmed using serum immunofixation, serum immunoelectrophoresis, or serum immunosubtraction. |
| Serum immunofixation | This test uses antibodies directed against heavy chain and light chain components to differentiate a monoclonal from a polyclonal increase in immunoglobulins and to determine the type of immunoglobulin involved (eg, IgG kappa). This test does not quantify the M-protein. |
| Serum free light chain (FLC) assay | The serum FLC assay is an antibody-based system that can detect low concentrations of monoclonal free light chains (ie, kappa or lambda) in the serum. This assay is more sensitive for the detection of light chains than urine immunofixation; however, results may be affected by the presence of renal failure. |
| Quantitation of immunoglobulins | This technique can detect hypogammaglobulinemia and hypergammaglobulinemia, but does not allow an assessment of clonality. Increased levels can be due to polyclonal or monoclonal elevations; clonality needs to be established using SPEP and immunofixation. |
| Studies on urine | |
| Dipstick testing | Although dipsticks are used in many laboratories to screen for the presence of protein in the urine, these tests are unable to detect Bence Jones protein (free kappa or lambda light chains). |
| Urine protein electrophoresis (UPEP) | The UPEP uses electrophoresis to separate urine proteins. A 24-hour urine collection is necessary to determine the quantity of M-protein. |
| Urine immunofixation | Urine immunofixation uses antibodies directed against the light chain components to differentiate a monoclonal from a polyclonal increase in immunoglobulins and to determine the type of light chain involved. Urine immunofixation is more sensitive than UPEP, but cannot estimate the size of the monoclonal protein. |
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