24 Resolution of Discrepant Results in Serum Protein Electrophoresis and Immunofixation Electrophoresis. (11th January 2018)

• Record Type: Journal Article
• Authors: Vick, Randol; Blakely, Katherine; Taylor, Sara; Han, Heping; Lewis, Sally
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S10
• Page End: S10
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx115.023
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Introduction: Serum protein electrophoresis (SPEP) from a 77-year-old male patient and a 33-year-old female patient showed an abnormal SPEP pattern with a M-spike in the beta region. The 77-year-old male patient had a 1 g/dL (17.6%) densitometer result in the beta fraction (normal range for beta fraction 0.6–1.3 g/dL) and the 33-year-old female patient had a 1.1 g/dL (14%) densitometer result in the beta fraction. These abnormal patterns were followed by an immunofixation electrophoresis (IFE), which did not reveal a distinctive monoclonal band in either patient. Methods: Although neither patient's samples appeared to show visible hemolysis, the samples were treated and incubated 1:1 with commercial thrombin reagent. Samples clotted after incubation with the thrombin, and a clot was removed from the sample. SPEP was repeated, and the initial M-spike in the beta region was not seen in the new SPEP. Conclusions: A variety of other proteins besides monoclonal proteins may contaminate a serum protein electrophoresis sample. Hemolysis causes decreased alpha-2 band (haptoglobin), and appearance of a hemoglobin band between the alpha-2 and beta-1 regions. Treatment of the sample with thrombin prior to electrophoresis resulted in a normal SPEP pattern and resolution of the discrepancies, and eliminated the need for further unnecessary testing.