My husband's paraprotein levels have begun showing up again after being too faint to quantitate for several months. The report from the lab lists his paraprotein level followed by the sentence "Migrates in the gamma region" It then states "Paraprotein previously identified as IgG lambda"
What is the significance of "migrates in the gamma region"?
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maryk - Name: maryk
- Who do you know with myeloma?: my husband
- When were you/they diagnosed?: July 2012
Re: Protein electrophoresis: "migrates in the gamma region"?
Hi Mary,
That's a good question. It's hard to answer, though, without giving a little background on how the electrophoresis test is carried out. I'm not a lab technician or pathologist, so I've never actually been in a pathology lab and carried out the test. However, the way I've seen it described is as follows.
First, you put the blood sample from the patient on the surface of a gel. Next, you apply an electrical charge for a period of time to the gel, so that one end of the gel is positively charged, and the other end is negatively charged. The charge causes the different types of proteins in the blood to move, or "migrate", to one end of the gel or the other.
What makes the test useful is that, if you consistently use the same kind of gel for the test, put the blood sample in the same place on the gel each time, and apply the charge in the same way, specific types of protein will always move (migrate) to the same specific areas (regions) of the gel.
As this type of testing was being developed, pathologists started naming the different regions on the gel. Eventually, those regions took on the names you see in electrophoresis test results -- names like Alpha-1, Alpha-2, Beta-1, Beta-2, and Gamma.
So, when someone says that a certain protein, such as a patient's paraprotein (monoclonal protein, or M-spike") "migrates in the gamma region" on an electrophoresis test, it means that the protein was found in Gamma area on the gel. Or, to put it the way we often hear it, the paraprotein is a "gamma globulin."
After the electrophoresis is done, the amount of protein found in each region of the gel is calculated. That's what you see in the SPEP reports. A technique is also used to determine how much abnormal protein --- the paraprotein, or M-spike -- is present, and, as I just described, the test will also tell you in what region (gamma, beta, etc.) the M-spike is present.
What the SPEP test can't tell you, however, is the exact type of the M-spike, i.e., IgG, IgA, etc. This is because, a lot of the time, these immunoglobulins show up in the same region on the gel, specifically the gamma region.
That's why you have to do another test, the serum immunofixation electrophoresis (IFE) test, to determine the specific immunoglobulin type of the paraprotein (IgG lambda, IgA kappa, etc.).
Got it?
I know this is probably a lot longer explanation than you expected, but, as I said at the beginning, it's hard to really explain the use of the word "migrate" when it's used in this sort of test without explaining things in detail.
If you are really interested in this kind of stuff, you may want to read this article:
"Understanding and Interpreting Serum Protein Electrophoresis," American Family Physician, Jan 1, 20015 (full text of article)
Whenever I'm looking up how to interpret serum electrophoresis reports, I often end up re-reading this article. It's a keeper.
Take care,
Jim
That's a good question. It's hard to answer, though, without giving a little background on how the electrophoresis test is carried out. I'm not a lab technician or pathologist, so I've never actually been in a pathology lab and carried out the test. However, the way I've seen it described is as follows.
First, you put the blood sample from the patient on the surface of a gel. Next, you apply an electrical charge for a period of time to the gel, so that one end of the gel is positively charged, and the other end is negatively charged. The charge causes the different types of proteins in the blood to move, or "migrate", to one end of the gel or the other.
What makes the test useful is that, if you consistently use the same kind of gel for the test, put the blood sample in the same place on the gel each time, and apply the charge in the same way, specific types of protein will always move (migrate) to the same specific areas (regions) of the gel.
As this type of testing was being developed, pathologists started naming the different regions on the gel. Eventually, those regions took on the names you see in electrophoresis test results -- names like Alpha-1, Alpha-2, Beta-1, Beta-2, and Gamma.
So, when someone says that a certain protein, such as a patient's paraprotein (monoclonal protein, or M-spike") "migrates in the gamma region" on an electrophoresis test, it means that the protein was found in Gamma area on the gel. Or, to put it the way we often hear it, the paraprotein is a "gamma globulin."
After the electrophoresis is done, the amount of protein found in each region of the gel is calculated. That's what you see in the SPEP reports. A technique is also used to determine how much abnormal protein --- the paraprotein, or M-spike -- is present, and, as I just described, the test will also tell you in what region (gamma, beta, etc.) the M-spike is present.
What the SPEP test can't tell you, however, is the exact type of the M-spike, i.e., IgG, IgA, etc. This is because, a lot of the time, these immunoglobulins show up in the same region on the gel, specifically the gamma region.
That's why you have to do another test, the serum immunofixation electrophoresis (IFE) test, to determine the specific immunoglobulin type of the paraprotein (IgG lambda, IgA kappa, etc.).
Got it?
I know this is probably a lot longer explanation than you expected, but, as I said at the beginning, it's hard to really explain the use of the word "migrate" when it's used in this sort of test without explaining things in detail.
If you are really interested in this kind of stuff, you may want to read this article:
"Understanding and Interpreting Serum Protein Electrophoresis," American Family Physician, Jan 1, 20015 (full text of article)
Whenever I'm looking up how to interpret serum electrophoresis reports, I often end up re-reading this article. It's a keeper.
Take care,
Jim
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JimNY
Re: Protein electrophoresis: "migrates in the gamma region"?
Jim, that was very informative! I can just see now how the process occurs. So it really has nothing to do with the paraproteins (M spike) but rather the globulins. I will definitely read that article you suggested. Thanks so much. Mary
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maryk - Name: maryk
- Who do you know with myeloma?: my husband
- When were you/they diagnosed?: July 2012
Re: Protein electrophoresis: "migrates in the gamma region"?
Hello MaryK:
I remember that one of the doctors who are good enough to contribute to the forum (off the top of my head I am not recalling exactly which one) had said that a shift of the MSpike is a "positive prognostic indicator".
In other words, good news.
I believe that the good doctor indicated that there was no good reason why it would be so, but the evidence of observing patients over many years was persuasive. Pls research this, and don't take my word for it, but I am thinking its good news. Best Regards, JPC
I remember that one of the doctors who are good enough to contribute to the forum (off the top of my head I am not recalling exactly which one) had said that a shift of the MSpike is a "positive prognostic indicator".
In other words, good news.
I believe that the good doctor indicated that there was no good reason why it would be so, but the evidence of observing patients over many years was persuasive. Pls research this, and don't take my word for it, but I am thinking its good news. Best Regards, JPC
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JPC - Name: JPC
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