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

Emails to chemicalpathologist@adhb.govt.nz will receive priority attention from the on-call chemical pathologist.

If the query concerns a specific patient please include the NHI number in your email.

If email is not a suitable option, please contact the on-call chemical pathologist via Lablink (Auckland City Hospital ext. 22000 or 09-3078995).

Individual chemical pathologists may be contacted but will not be available at all times.

After-hours : contact Lablink (Auckland City Hospital ext. 22000 or 09-3078995) or hospital operator for on duty staff after hours.

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 : wenyiyi@adhb.govt.nz ext. 22045

Last updated at 18:42:49 03/12/2024