Labcorp
Labcorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.
Labcorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.
To help diagnose or monitor conditions that result in abnormal protein production or loss of protein
When you have an abnormal result on a total protein, albumin, or immunoglobulins blood test; when you have symptoms of a disease that is associated with abnormal protein production such as multiple myeloma, Waldenstrom macroglobulinemia, amyloidosis, monoclonal gammopathy of underdetermined significance (MGUS), lymphoma, chronic lymphocytic leukemia or multiple sclerosis
Protein electrophoresis is typically performed on serum (the fluid portion of blood), urine samples or, in certain circumstances, cerebrospinal fluid (CSF). Serum is obtained by collecting a blood sample by inserting a needle into a vein. Urine samples may either be collected as a random sample (not timed) or a 24-hour urine sample. CSF is collected by a spinal tap (also known as lumbar puncture, which is inserting a needle into the spinal canal to withdraw spinal fluid).
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Proteins are important building blocks of all cells and tissues. They form the structural part of most organs and make up enzymes and some hormones that regulate bodily functions. Protein electrophoresis is a lab method that separates proteins based on their size and electrical charge. Knowing which proteins are present, absent, elevated, or decreased in body fluids such as blood can help diagnose and/or monitor various diseases and conditions.
Body fluids, such as blood, urine, and cerebrospinal fluid (CSF) contain many different proteins that have various roles, such as transporting nutrients, removing toxins, and controlling body functions.
The two major types of proteins are:
The various proteins in body fluids are subjected to a controlled electric current, fractionating them into a typical pattern of bands or peaks that then can be measured. The proteins are divided into six groups, called prealbumin (rarely detected on serum or urine protein electrophoresis), albumin, alpha 1, alpha 2, beta, and gamma. The beta fraction may be further divided into beta 1 and beta 2 subgroups.
Each of these protein groups (electrophoresis fractions) is distinct and at specific concentrations. The patterns typically seen in certain conditions and diseases can help with diagnosis. The major serum proteins and their functions are listed according to their electrophoretic region or fraction (the visible band that they are part of) in the table titled Protein Groups.
Various conditions and diseases can affect protein production and/or protein loss, thus changing the pattern of bands seen on a protein electrophoresis. The most important example is the appearance of a distinct, monoclonal band in the gamma region. For example, uncontrolled growth and division of a malignant plasma cell as seen in multiple myeloma leads to the production of large amounts of a single type of immunoglobulin (monoclonal immunoglobulin).
When an abnormal protein (band or peak) is detected, additional tests are done to identify the type of protein (immunotyping). Immunofixation electrophoresis or immunosubtraction electrophoresis can be used to identify abnormal bands seen on protein electrophoresis, typically in the gamma region, in order to determine whether a type of antibody (immunoglobulin) is abnormally produced (e.g., IgG, IgA, IgM).
In most cases of multiple myeloma, a single type of intact (whole) immunoglobulin is produced in excess. In a minority of cases, only one section of an immunoglobulin called a "free light chain" is produced in large amounts. These excess free light chains are released into the bloodstream and since they are relatively small molecules, they are filtered by the kidneys and released into the urine. Another term for these excess free light chains in the urine is Bence Jones proteins.
Protein electrophoresis is used to identify and measure the presence of abnormal proteins, the absence of normal proteins, and/or to detect various protein electrophoresis patterns associated with certain conditions, as found in blood, urine or other body fluids.
The information from protein electrophoresis can provide clues that a disease or condition is affecting protein production or loss of protein, but the results usually do not provide a definitive diagnosis. Instead, additional follow-up tests are needed to investigate the cause and to try to identify the nature of the underlying disease.
Serum electrophoresis may be used to:
Urine protein electrophoresis may be used:
When an abnormal band on either a serum or a urine electrophoresis pattern suggests the presence of a single type of immunoglobulin (monoclonal), immunofixation electrophoresis (IFE) or immunosubtraction electrophoresis can be used as follow-up tests to further identify abnormal proteins.
CSF protein electrophoresis may be used:
Protein electrophoresis is a common test ordered when you have symptoms suggesting certain conditions. Some examples are listed below.
Serum and urine protein electrophoresis may be ordered when you have signs and symptoms of multiple myeloma, such as:
Urine protein electrophoresis may be ordered when you have abnormally high levels of protein in your urine.
Immunofixation electrophoresis or immunosubtraction electrophoresis may be ordered when an abnormal band suggestive of a monoclonal immunoglobulin is detected on either a serum or a urine electrophoresis.
CSF protein electrophoresis may be ordered:
Once a disease or condition has been diagnosed, electrophoresis may be ordered at regular intervals to monitor the course or recurrence of the disease and the effectiveness of treatment.
Protein electrophoresis tests give a healthcare practitioner a rough estimate of how much of each of the protein fractions is present and whether any abnormal proteins or protein patterns are present.
Results are interpreted along with your signs and symptoms and medical history. The laboratory report usually includes an interpretation of the results.
Serum protein electrophoresis
The following table summarizes the conditions or diseases that may be associated with decreases or increases in various serum proteins.
Electrophoretic zone/region | Major Proteins | May be decreased in: | May be increased in: |
Albumin |
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Alpha 1 |
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Alpha 2 |
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Beta (1 and 2) |
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Gamma |
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Urine protein electrophoresis
Usually there is very little protein in urine. Typically, if a significant amount of protein is present (proteinuria), it appears in one of three main patterns:
CSF protein electrophoresis
Immunofixation electrophoresis or immunosubtraction capillary electrophoresis identifies the type of immunoglobulin protein(s) present as monoclonal bands on a protein electrophoresis pattern. Typically, this testing determines the presence and type of monoclonal proteins (e.g., IgG kappa). For more about this, read the article on Multiple Myeloma.
It depends on the condition or disease that is suspected. If your healthcare practitioner needs additional information to evaluate your condition and make a diagnosis, follow-up testing may include, for example:
Immunoglobulins are part of the body’s natural defense system and are produced by plasma cells in the bone marrow. They are composed of four protein chains–two identical heavy (long) protein chains and two identical light (shorter) protein chains.
Within a plasma cell, two heavy chains of one type and two light chains of one type become attached to form one intact immunoglobulin molecule. Each particular plasma cell will produce only one type of immunoglobulin. These chains that are used to form the immunoglobulins are said to be "immunoglobulin-bound." Normally, there is a slight excess of kappa and lambda light chains produced (free light chains).
However, in diseases such as in multiple myeloma, the plasma cells may produce excessive or mutated light chains that do not associate with heavy chains. These abnormal free light chains can be detected with a free light chain test. The ratios between the kappa and lambda free light chains also can be evaluated. An abnormal ratio and increased levels of one serum free light chain are often associated with diseases. For more information, see the article on Serum Free Light Chains.
They are free immunoglobulin light chains that are found in the urine. These free light chains can be caused by certain forms of multiple myeloma.
Not necessarily. Monoclonal protein production may be due to a condition known as monoclonal gammopathy of undetermined significance (MGUS). Most people with MGUS initially have a benign course but may progress to a more serious condition. They must continue to be monitored regularly with a serum protein electrophoresis test, or sometimes a free light chain test, depending on which monoclonal protein is being produced. MGUS is present in about 4% of Caucasians over the age of 50 and progresses at a rate of 1% per year to multiple myeloma.
Yes, it may be used any time a separation of molecules is desired. Hemoglobin electrophoresis, for instance, is used to help detect abnormal forms of hemoglobin, such as HbS variant that cause sickle cell anemia or in various forms of thalassemia. Electrophoresis is also used in certain circumstances to separate different forms of enzymes, called isoenzymes, lipoproteins (e.g., LDL, HDL) or DNA and RNA fragments. These are only a few examples of electrophoresis applications in clinical laboratories and research.
Immunizations within the previous six months can increase antibodies (immunoglobulins), as can drugs such as phenytoin (Dilantin), procainamide, oral contraceptives, methadone, and intravenous immunoglobulin (IV Ig) and anti-cancer immunotherapy.
Aspirin, bicarbonates, chlorpromazine (Thorazine), corticosteroids, and neomycin can affect protein electrophoresis results.
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