QUANTIFICATION OF KAPPA AND LAMBDA TO AID THE DIAGNOSIS OF MONOCLONAL GAMMOPATHIES

Identification of monoclonal gammopathies in serum has involved electrophoresis of serum proteins, immunoelectrophoresis (IEP), and quantification of IgG, IgA, and IgM. Due to the poor resolution of IEP, small monoclonal gammopathies and often IgM monoclonal proteins were not efficiently identified. Recent innovations in technology-including high-resolution electrophoresis (HRE), immunofixation (IFE), and quantification of kappa- and lambda-containing immunoglobulins-allow for more rapid and precise assessment of serum for monoclonal proteins. We present a series of guidelines to determine when high-resolution electrophoresis and quantification of immunoglobulins (including kappa and lambda) are sufficient and when additional IFE is required to characterize the monoclonal gammopathy. The guidelines allow us to detect monoclonal gammopathies quicker and more efficiently by avoiding redundant IEP or IFE testing. A key to all evaluations for monoclonal gammopathy is that a urine sample must be studied for the presence of Bence Jones proteins (monoclonal free light chains). For the vast majority of cases the use of these guidelines allows for a correct diagnosis within one day.