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The serum free light-chain assay in combination with serum protein electrophoresis and serum immunofixation electrophoresis is sufficient to screen for pathological monoclonal plasmaproliferative disorders other than AL amyloidosis which requires all the serum tests as well as 24 h urine immunofixation electrophoresis.
Pipetting anti-immunoglobulins to immunofixation panel. The panel simultaneously tests 4 patients (one in each quadrant). Each patient has 6 electrophoresis panels: The left one is a conventional serum protein electrophoresis. The remainder get solutions with anti-IgG, anti-IgA, anti-IgM, anti-kappa light chain and anti-lambda light chain ...
type 3, oligoclonal bands in CSF and serum with additional bands in CSF; type 4, identical oligoclonal bands in CSF and serum, type 5, monoclonal bands in CSF and serum, type 6, presence of a single band limited to the CSF. Type 2 and 3 indicate intrathecal synthesis, and the rest are considered as negative results (No MS).
Serum protein electrophoresis or immunofixation is positive in 67-100% of cases, while urine protein electrophoresis or immunofixation is positive in 50-100% of cases. [2] Serum free light chain measurement is positive in 100% of cases, evidence that the underlying monoclonal plasma cells secrete free light chains as well as heavy chains.
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Immunoelectrophoresis and immunofixation studies help identify the type of immunoglobulin, the light chain's clonality, and the paraprotein's monoclonality and quantitation. High-resolution electrophoresis and serum and urine immunofixation are recommended to help identify and characterize the monoclonal IgM paraprotein.