Specimen Collection
Heparin tube specimen NOT suitable (fibrinogen band can be confused with a paraprotein band).
3.5 mL SST Serum (Preferred)
20 mL Urine (Random)
4 mL Plain Blood
1 mL Paediatric Microsample Blood
24hr Urine.
Reference Intervals
Monoclonal gammopathies
If a monoclonal band is detected by electrophoresis, immunofixation will be performed to identify it and band quantitation will be performed by densitometry.
Band quantitation is the recommended method for monitoring patients who have a quatifiable paraprotein band in serum. Band quantitation will always be performed on all samples from the patient. The uncertainty of measurement for band quantitation is 15%.
Quantitation of urine monoclonal light chains (Bence-Jones protein) is done by densitometry and is reported as the paraprotein / creatinine ratio.
Immunofixation will only be performed on the initial sample, unless the pattern of bands changes.
Immunofixation is not usually performed if the electrophoresis pattern looks normal. However, in cases of neuropathy (where inflammatory demyelinating neuropathy is suspected) it is necessary to do immunofixation; in these cases "NEUROPATHY - immunofixation required" should be written clearly on the request form under Clinical Details.
The free light chains assay is useful in amyloidosis, light chain myeloma, and non-secretory myeloma. This assay has a very high imprecision and should not be used for monitoring myeloma / MGUS patients with a quantifiable paraprotein band in serum. See Free Light Chains - blood
Both urine and serum specimens should be tested if myeloma is suspected. 20% of myeloma patients have an abnormal band in the urine, but not in the serum.
Proteinuria classification
On the basis of the urine protein electrophoresis pattern, proteinuria may be classified as:
- selective glomerular proteinuria ( only albumin and transferrin present)
- nonselective glomerular proteinuria ( all plasma proteins present, to varying degrees)
- tubular proteinuria ( predominantly low MW proteins, indicating tubular damage)
Turnaround Time:
Protein
electrophoresis is performed only on weekdays. The turnaround times are 5 days
for serum and urine electrophoresis, and if immunofixation is required, an
extra 3 working days
Contact Information
For any further information contact the chemical pathologist via email
chemicalpathologist@adhb.govt.nz
or via Lablink (Auckland City Hospital) EXT 22000 or 09 3078995.
Dr Cam Kyle (Clinical Head):
CampbellK@adhb.govt.nz
ext 22052
Dr Weldon Chiu:
WeldonC@adhb.govt.nz
ext. 23427
Dr Samarina Musaad:
SamarinaM@adhb.govt.nz
ext. 22402
Dr Campbell Heron:
CHeron@adhb.govt.nz
ext. 23427
Dr Sakunthala Jayasinghe:
sakunthala@adhb.govt.nz
ext. 23427
Dr Owen Yi (Registrar):
wenyiyi@adhb.govt.nz
ext. 22045