A study to Evaluate Immunoglobulins fraction by Serum Protein Electrophoresis for occurrence of Multiple Myeloma in a Tertiary Care Hospital

Abstract

Background: Serum protein electrophoresis (SPE) is a diagnostic laboratory test that separates and quantifies several classes of serum proteins and that identifies and characterizes the monoclonal gammopathies (M-protein). Aims and Objective: This study was taken up with an aim to evaluate the relevance and significance of immunoglobulin fraction in discerning multiple myeloma and to assess the morbidity of cases in relation to its clinical diagnosis. Materials and Method: This study was carried out by analysing data with gamma globulins above biological reference range (0.6-1.6gm/dL) from the samples requested for serum protein electrophoresis by cellulose acetate method during Sept 2013 to Aug 2014 in St. Johns medical college biochemistry lab, Bengaluru (Total of 95 cases). Densitometrically estimated M proteins were further divided into 2 groups of below and above 3gm/dL according to the IMWG criteria for classification of Multiple myeloma. Result: Out of 95 cases, 55(57.9 %) were above 3gm/dL and the remaining 40(42.1%) were below 3gm/dL. Among those 95 cases 18 were confirmed with multiple myeloma. 13 out of 18 cases fall among the group where gamma globulin is > 3g/dL with 81% of them having gamma above 4g/dL. Five cases of multiple myeloma had also been confirmed with their gamma globulins falling below 3g/dL which is compelling. Conclusion: The significance of elevated gamma globulins value less than the prescribed criteria of IMWG for diagnosing Multiple myeloma gave us importance of clinical correlation before releasing report. Though the morbidity percentage (20%) of multiple myeloma among the group with gamma globulins less than 3gm/dL, is less but nevertheless significant.More number of studies with large sample numbers is required to understand the cases of multiple myeloma with their gamma globulins falling below the IMWG criteria cut off limit.