[emkittie]

Abnormal findings - serum protein electrophoresis (SPEP)

by emkittie on Tue Dec 22, 2015 12:36 pm

After several weeks of intermittent low-grade fevers this summer, I saw my internist, who sent me for a bunch of labs. (Ironically I went for my diagnostic mammogram at that time and was diagnosed with early stage breast cancer. The fevers were attributed to a urinary tract infection, of which I had absolutely no symptoms.) I recently was checking for results of some labwork and came upon an serum protein electrophoresis (SPEP) and immunofixation electrophoresis test which stated the following:

ABNORMAL: Serum protein electrophoresis detected abnormal monoclonal proteins with preservation of polyclonal immuno­globulins in the beta region. The abnormal protein was identified by immunofixation electrophoresis, August 5, 2015, as a monoclonal IgG Kappa. The monoclonal protein cannot be quantified because it is found in the beta region where it co-migrates with abundant other proteins. These results can be seen in the setting of a plasma cell dyscrasia or lympho­pro­liferative disorder. Serum quantitative immunoglobulins should be ordered and a urine specimen, preferably a 24-hour collection, should be sent for protein electrophoresis and immunofixation."

All the serum protein samples, etc. were within normal range.

My internist never mentioned this to me and it's got me a bit confused. I've scheduled an appointment to see her next month to discuss these results, but I'm not quite sure what to ask her. I guess I thought if she didn't say anything to me, these results are what I call "incidentalomas" and are nothing I should be concerned with. However, when I started researching what a monoclonal protein was, it sort of nagged at me. Just wanted some advice on whether my worries are baseless.

Thanks for listening!

[Multibilly]

Re: Abnormal findings - serum protein electrophoresis (SPEP)

by Multibilly on Tue Dec 22, 2015 5:04 pm

Hi Emkittie,

Welcome to the forum.

Having monoclonal protein present in your blood is not normal. Sometimes, the monoclonal protein that is detected by serum immunofixation can indeed "live" on a portion of the electrophoresis graph occupied by other normally present proteins, making it impossible to measure the monoclonal protein accurately. But this doesn't mean that it shouldn't be investigated further. Also note that internists are not nearly as familiar with plasma cell disorders and the nuances of tracking down monoclonal protein issues as are hematologists.

I'm not a doc, but the follow-up tests recommend in the lab results, plus a serum free light chain assay would be prudent IMHO. The internist should therefore be ordering:

Quantified immunoglobulins test
24 hour urine protein electrophoreis (UPEP)
Serum free light chain assay

In the meantime, you might want to go back and look at your CBC and metabolic panel tests and see if your total protein and total globulin levels are in range. It might also be insightful to look at your serum calcium, hemoglobin and creatinine levels. These levels might provide additional clues as to whether a plasma cell disorder is in play.