Despite an overall good performance on all laboratory procedures used to detect monoclonal (M) proteins or paraproteins, mis- or false-diagnoses have been seen using electrophoresis methods, especially on cases with non-classic abnormal immunoglobulin profiles. This session will highlight cases with these challenging profiles and present solutions using multi-method approach or mass spectrometry to address potential misdiagnosis. In addition, monoclonal antibodies (mAb) used as immune-modulatory therapy have been emerging for the treatment of cancers including multiple myeloma and autoimmune diseases. Clinical laboratorians and pathologists should be aware of the interference from mAb therapeutics on M protein assessment. In this session, we will present a comprehensive overview of laboratory methods used for paraproteinemia analysis and ways to identify/eliminate interferences associated with these methods. Mass spectrometry-based analysis (MASS-FIX assay) of M proteins provides another option in investigation of abnormal cases. The advantage of mass spectrometry-based method over conventional electrophoresis will also be discussed.

Learning Objectives:

1. Summarize the advantages and limitations of various methodologies used for paraproteinemia analysis.

2. Review the advantage of using mass spectrometry-based method over conventional electrophoresis method on abnormal paraproteinemia cases.

3. Develop knowledge on latest technologies and approaches used to eliminate interferences on M protein analysis from mAb therapeutics.