AUG 21, 2013 06:00 AM PDT

M-protein Evaluation in an Age of Automation: Capillary Electrophoresis, Free Light Chains & Heavy-Light Measurements

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  • Professor, Department of Pathology, Associate Director, Clinical Pathology Laboratories, University of Michigan Health System
      Dr. Keren received his B.S., M.S. and M.D. degrees from the University of Illinois, the latter in 1971. He completed his residency training in Anatomic and Clinical Pathology and postdoctoral training in Immunopathology and Immunohematology at The Johns Hopkins Hospital from 1971-1976. From 1976-1978 he served as a Major in the United States Armed Forces at the Walter Reed Army Institute for Research in Washington, D.C. He joined the Department of Pathology of the University of Michigan in 1978. From 1989 through 2011 he served as the Medical Director of Warde Medical Laboratory while continuing as an Adjunct Clinical Professor of Pathology at the University of Michigan. Dr. Keren has authored over 160 peer-reviewed articles and has written or edited 13 books. He has received several awards including the Carl A. Jolliff Award from the Clinical and Diagnostic Immunology Division of the American Association of Clinical Chemists, a Lifetime Achievement Award from the Michigan Society of Pathologists, the Israel Davidsohn Award, the Distinguished Service Award, and the Mastership Award from the American Society for Clinical Pathology. Dr. Keren served as the President of the Gastrointestinal Pathology Society (1993), President of the Michigan Society of Pathologists (2000), President of the American Society for Clinical Pathology (2003), and President of the American Board of Pathology (2011). Currently, he is a Trustee of the American Board of Pathology and a member of the CAP Hematology and Clinical Microscopy Resource Committee.


    This presentation focuses on contemporary methods for detection of monoclonal proteins (M-protiens) that are associated with multiple myeloma and other plasma cell dyscrasias. The basic principles of the techniques currently used will be presented along with a triage that can be used for their implementation. None of the techniques is without the hazards of false positive and false negative results. When using serum protein electrophoresis as the screen, the main causes for false positives include the presence of fibrinogen and genetic variants of normal serum proteins. When capillary electrophoresis is used to screen serum, radiocontrast dyes and some antibiotics can mimic M-proteins. False negatives occur because will be demonstrated along with tactics to prevent them. Serum free light chain testing is a boon to detecting multiple myeloma without requiring a 24 hour urine sample, however the user needs to be aware of the high-dose hook effect which can produce falsely low results. The newest serologic test is able to measure heavy and light chain specific pairs, i.e. distinguishing between populations of IgG kappa and IgG lambda. These reagents may aid in classification and risk stratification, but more independent research will be needed to determine their utility.

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