DMOGA / Monoclonal Gammopathy, Diagnostic, Serum which includes MALDI-TOF MS and serum free light chains, should be done to screen if the clinical suspicion is high. Accordingly, a normal serum SPE does not rule out the disease and SPE should not be used to screen for the disorder. Approximately 8% of MM patients have hypogammaglobulinemia without a quantifiable M-spike on SPE but identified by MALDI-TOF MS. Approximately 11% of patients with MM have a completely normal serum SPE, with the monoclonal protein only identified by MALDI-TOF MS. Patients suspected of having a monoclonal gammopathy may have normal serum SPE patterns. A decrease or increase of the M-spike that is greater than 0.5 g/dL is considered a significant change. However, if the monoclonal protein falls within the beta region (most commonly an IgA or an IgM) quantitative immunoglobulin levels may be more a useful tool to follow the monoclonal protein level than SPE.

The initial identification of an IgM, IgA, or IgG M-spike greater than 4 g/dL, greater than 5 g/dL, and greater than 6 g/dL respectively, should be followed by VISCS / Viscosity, Serum.Īfter the initial identification of an M-spike, quantitation of the M-spike on follow-up SPE can be used to monitor the monoclonal gammopathy. The initial identification of a serum M-spike greater than 1.5 g/dL on SPE should be followed by MPSU / Monoclonal Protein Study, 24 Hour, Urine.

A monoclonal IgM of greater than 3 g/dL is consistent with macroglobulinemia. A monoclonal IgG or IgA of less than 3 g/dL may be consistent with monoclonal gammopathy of undetermined significance (MGUS), primary systemic amyloidosis, early or treated myeloma, as well as a number of other monoclonal gammopathies. A monoclonal IgG or IgA of greater than 3 g/dL is consistent with multiple myeloma (MM). Immunoaffinity purification followed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) i s performed to identify any immunoglobulin heavy and light chains present. The finding of an M-spike, restricted migration, or hypogammaglobulinemic SPE pattern is suggestive of a possible monoclonal protein. A characteristic monoclonal band (M-spike) is often found on serum protein electrophoresis (SPE) in the gamma globulin region and, more rarely, in the beta or alpha-2 regions.

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