Sorted By Test Name - Mayo Medical Laboratories

RMPSU
60069
MPSS
81756
Monoclonal Protein Study, Random, Urine
Clinical Information: Urine proteins can be grouped into 5 fractions by protein electrophoresis:
-Albumin -Alpha-1 -Alpha-2 -Beta-globulin -Gamma globulin The urine total protein concentration, the
electrophoretic pattern, and the presence of a monoclonal immunoglobulin light chain may be
characteristic of monoclonal gammopathies such as multiple myeloma, primary systemic amyloidosis,
and light-chain deposition disease. The use of a random urine specimen is sufficient for identifying the
presence or absence of a monoclonal immunoglobulin, but a 24 hour specimen is preferred for
quantitating and monitoring the abnormality. See An Expanded Algorithm for the Laboratory Evaluation
of Suspected Multiple Myeloma in Special Instructions and the Laboratory Approach to the Diagnosis of
Amyloidosis algorithm in Special Instructions. Also see Diagnosis and Monitoring of Multiple Myeloma
in Publications.
Useful For: Diagnosing monoclonal gammopathies
Interpretation: A characteristic monoclonal band (M-spike) is often found in the urine of patients with
monoclonal gammopathies. The initial identification of an M-spike or an area of restricted migration is
followed by immunofixation to identify the immunoglobulin heavy chain and/or light chain.
Immunoglobulin free light chains as well as heavy chain fragments may be seen in the urine of patients
with monoclonal gammopathies. The presence of a monoclonal light-chain M-spike of >1 g/24 hours is
consistent with a diagnosis of multiple myeloma or macroglobulinemia. The presence of a small amount
of monoclonal light chain and proteinuria (total protein >3 g/24 hrs) that is predominantly albumin is
consistent with primary systemic amyloidosis (AL) or light-chain deposition disease (LCDD). Because
patients with AL or LCDD may have elevated urinary protein without an identifiable M-spike, urine
protein electrophoresis is not considered an adequate screen for these disorders and immunofixation is
also performed.
Reference Values:
ELECTROPHORESIS, PROTEIN
The following fractions, if present, will be reported as a percent of the total protein:
Albumin
Alpha-1-globulin
Alpha-2-globulin
Beta-globulin
Gamma-globulin
No reference values apply to random urine.
Clinical References: Kyle RA, Katzmann JA, Lust JA, Dispenzieri A: Clinical indications and
applications of electrophoresis and immunofixation. In Manual of Clinical Laboratory Immunology. 6th
edition. Edited by NR Rose, et al. Washington, DC, ASM Press, 2002, pp 66-67
Monoclonal Protein Study, Serum
Clinical Information: Serum proteins can be grouped into 5 fractions by protein electrophoresis:
-Albumin, which represents almost 2/3 of the total serum protein -Alpha-1, composed primarily of
alpha-1-antitrypsin (A1AT), an alpha-1-acid glycoprotein -Alpha-2, composed primarily of
alpha-2-macroglobulin and haptoglobin -Beta, composed primarily of transferrin and complement C3
-Gamma, composed primarily of immunoglobulins (Ig) The concentration of these fractions and the
electrophoretic pattern may be characteristic of diseases such as monoclonal gammopathies, A1AT
deficiency disease, nephrotic syndrome, and inflammatory processes associated with infection, liver
disease, and autoimmune diseases. See Laboratory Screening Tests for Suspected Multiple Myeloma and
the Laboratory Approach to the Diagnosis of Amyloidosis algorithm in Special Instructions. Also see
Diagnosis and Monitoring of Multiple Myeloma in Publications.
Useful For: Diagnosis of monoclonal gammopathies, when used in conjunction with urine monoclonal
studies Monitoring patients with monoclonal gammopathies Protein electrophoresis alone is not
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