Immunofixation (IFE), Serum, Protein Electrophoresis (PE), Serum, and Quantitative Free κ and λ Light Chains (FLC) Plus Ratio, Serum

CPT: 82784(3); 83883(x2); 84155; 84165; 86334
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Test Details

Synonyms

  • Free Light Chains, Quantitative, Serum
  • Freelite®
  • Globulins, Serum
  • IEP, Serum
  • IFE, Serum and Protein Electrophoresis, Serum
  • Immunoelectrophoresis for Myeloma Proteins
  • Kappa Free Light Chains, Quantitative, Serum
  • Kappa:Lambda Free Light Chains Ratio, Quantitative, Serum
  • Lambda Free Light Chains, Quantitative, Serum
  • Light Chains, Free κ and Free λ, Quantitative, Serum
  • Protein IEP
  • Serum IFE

Test Includes

Quantitation of serum immunoglobulins IgA, IgG, and IgM; IFE qualitative interpretation of heavy- and light-chain patterns; serum protein electrophoresis; quantitation of serum free κ and λ light chains plus κ:λ ratio

Use

Detect and identify monoclonal gammopathy (M protein) found on serum protein electrophoresis; diagnose myeloma, macroglobulinemia of Waldenström; evaluate amyloidosis; evaluate lymphoproliferative disease (malignant lymphoma and others) and collagen disease in general; diagnose and characterize immune deficient and dysgammaglobulinemic states

Methodology

Electrophoresis followed by immunodiffusion against monospecific antisera to immunoglobulin and individual heavy and light chains (IFE); protein electrophoresis on agarose media; turbidimetric quantitation of IgA, IgG, and IgM; immunologic quantitation of free κ and λ light chains

Additional Information

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) recommend the use of serum free light chain assays in the initial diagnostic work-up of multiple myeloma and related disorders.

"Use of free light chain (FLC) assay along with SPEP and SIFE yields high sensitivity while screening for MM and related plasma cell disorders. Therefore, this assay is now included as a part of the initial diagnostic work-up in the NCCN Multiple Myeloma Guidelines."1

If screening for plasma cell dyscrasias, the International Myeloma Working Group recommends a screening panel consisting of serum free light chain assay, serum protein electrophoresis (SPEP), and serum immunofixation (IFE) to maximize sensitivity. (A 24-hour urine IFE can be added if AL amyloidosis is suspected.)2

Specimen Requirements

Specimen

Serum

Volume

5.5 mL

Minimum Volume

2.2 mL

Container

Red-top tube or gel-barrier tube

Patient Preparation

Patient should be fasting.

Collection

Separate serum from cells.

Storage Instructions

IFE: Refrigerated. PE and FLC: Room temperature

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Gross hemolysis; gross lipemia

Clinical Information

Special Instructions

State patient's age and clinical diagnosis on the test request form.

Footnotes

1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) for Multiple Myeloma, Version 1.2011. Fort Washington, Pa: NCCN; 2011.
2. Dispenzieri A, Kyle R, Merlini G, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia. 2009 Feb; 23(2): 215-224.19020545

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
120256 IFE, PE and FLC, Serum 321881 . N/A
120256 IFE, PE and FLC, Serum 321882 IFE and PE, Serum N/A
120256 IFE, PE and FLC, Serum 001776 Immunoglobulin G, Qn, Serum mg/dL 2465-3
120256 IFE, PE and FLC, Serum 001784 Immunoglobulin A, Qn, Serum mg/dL 2458-8
120256 IFE, PE and FLC, Serum 001792 Immunoglobulin M, Qn, Serum mg/dL 2472-9
120256 IFE, PE and FLC, Serum 001073 Protein, Total, Serum g/dL 2885-2
120256 IFE, PE and FLC, Serum 149520 Albumin g/dL 2862-1
120256 IFE, PE and FLC, Serum 149521 Alpha-1-Globulin g/dL 2865-4
120256 IFE, PE and FLC, Serum 149522 Alpha-2-Globulin g/dL 2868-8
120256 IFE, PE and FLC, Serum 149523 Beta Globulin g/dL 2871-2
120256 IFE, PE and FLC, Serum 149524 Gamma Globulin g/dL 2874-6
120256 IFE, PE and FLC, Serum 149525 M-Spike g/dL 33358-3
120256 IFE, PE and FLC, Serum 149530 Globulin, Total g/dL 2336-6
120256 IFE, PE and FLC, Serum 149531 A/G Ratio 1759-0
120256 IFE, PE and FLC, Serum 149519 Immunofixation Result, Serum 13169-8
120256 IFE, PE and FLC, Serum 149534 Please note: N/A
120256 IFE, PE and FLC, Serum 001498 PDF N/A
120256 IFE, PE and FLC, Serum 121138 Free Kappa Lt Chains,S mg/L 36916-5
120256 IFE, PE and FLC, Serum 121139 Free Lambda Lt Chains,S mg/L 33944-0
120256 IFE, PE and FLC, Serum 121140 Kappa/Lambda Ratio,S 48378-4
Reflex Table for Immunofixation Result, Serum
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 149532 Immunofixation Interp.,Sr 149532 Immunofixation Interp.,Sr 13169-8

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