Evaluation and characterization of monoclonal gammopathies using serum protein electrophoresis in a major urban population: one institution’s experience

Introduction Serum protein electrophoresis (SPEP) with serum protein immunofixation electrophoresis (SPIFE) are clinical laboratory techniques used to identify, evaluate and monitor a wide range of disease states where abnormal serum protein levels are observed. 1 Such disorders include solid tumors, lymphoproliferative disorders (eg, multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS), Waldenström macroglobulinemia, primary amyloidosis, chronic lymphocytic leukemia, lymphoma), acute and chronic infections, trauma, connective tissue diseases, and liver disorders. 2 Clinical indications for ordering SPEPs are varied: suspected lymphoproliferative disorders; unexplained back pain, anemia, weakness or fatigue; osteolytic lesions; unexplained renal insufficiency; hypercalcemia; unexplained peripheral neuropathy; elevated erythrocyte sedimentation rate; and recurrent infections. 2 Changes observed in SPEPs follow predictable patterns guiding clinicians toward correct interpretation and diagnosis. Various disease states were observed, suggesting the wide application that SPEP studies are used at our institution. Since it is well known that MG disproportionately affects blacks more than Caucasians and Asians, we looked at SPEP/SPIFE characteristics within our unique, homogeneous Afro-Caribbean patient population, where little data exist. F, 1:4.3), a finding discordant with the literature and warrants further investigation. 10 Limitations include its small sample size, the nature of retrospective analysis and homogeneous patient population. Since SPEP orders did not discriminate between patients with a known history of a lymphoproliferative disorder who were being monitored for relapse and/or treatment response compared with a patient initially being evaluated for an immunoproliferative disorder, the results positively favor a higher observed MG incidence rate (32%) than reported in the literature for blacks (8.4%) and Caucasians (0.5%-3.8%).