What Is Serum Protein Electrophoresis

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When Is It Ordered

What is a Serum Protein Electrophoresis (SPEP)?

Protein electrophoresis is a common test ordered when you have symptoms suggesting certain conditions. Some examples are listed below.

Serum and urine protein electrophoresis may be ordered when you have signs and symptoms of multiple myeloma, such as:

  • Weakened bones that can result in soft spots, fractures, bone lesions and bone pain
  • Carpal tunnel syndrome
  • Destruction of bone that frequently increases the level of calcium in the blood, leading to symptoms such as loss of appetite, nausea, thirst, fatigue, constipation, and confusion
  • Frequent infections
  • Excessive bleeding and bruising
  • Kidney diseaselarge amounts of protein in the urine due to some forms of multiple myeloma can affect the kidneys and may permanently damage them.
  • In some cases, an increase in the thickness of the blood may lead to headaches, problems with vision, seizures, or even coma.

Urine protein electrophoresis may be ordered when you have abnormally high levels of protein in your urine.

Immunofixation electrophoresis or immunosubtraction electrophoresis may be ordered when an abnormal band suggestive of a monoclonal immunoglobulin is detected on either a serum or a urine electrophoresis.

CSF protein electrophoresis may be ordered:

  • When you have headaches or other neurologic symptoms to look for proteins suggestive of inflammation or infection
  • How Do Doctors Treat Diabetes

    The goal of treatment is to control your blood sugar and keep it in a healthy range. Doctors treat diabetes with medicines and a diabetes eating plan:

    • For type 1 diabetes, insulin shots are the main treatment. They replace the hormone your body is not able to make.
    • For type 2 diabetes, doctors use different medicines. These medicines work to lower your blood sugar. Sometimes is it possible to reverse type 2 diabetes by losing weight.
    • For both types, to control your blood sugar, doctors and dietitians help you create and follow a diabetes eating plan and be active.

    To know if your treatment is working, you will need to have tests to check your blood sugar often.

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    Icipant Selection Sample Size Calculation And Sampling Method

    Participant Selection and Sample Size Calculation

    As per CLSI Guideline EP28A3C recommendation, the best way to establish an RI is to collect samples from a sufficient number of reference individuals to yield a minimum of 120 samples for analysis, by non-parametric means for each partition with a power of 90%. One of the IFCCs primary recommendations, the posteriori sampling approach, was employed as a direct means to determine RI. Thus, to obtain a minimum recommended sample size for two partitions, a total of 297 samples were obtained by considering a 20% rejection rate13 from already collected samples.

    Sampling Method

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    Why The Test Is Performed

    Proteins are made from amino acids and are important parts of all cells and tissues. There are many different kinds of proteins in the body, and they have many different functions. Examples of proteins include enzymes, certain hormones, hemoglobin, low-density lipoprotein , and others.

    Serum proteins are classified as albumin or globulins. Albumin is the most abundant protein in the serum. It carries many small molecules. It is also important for keeping fluid from leaking out from the blood vessels into the tissues.

    Globulins are divided into alpha-1, alpha-2, beta, and gamma globulins. In general, alpha and gamma globulin protein levels increase when there is inflammation in the body.

    Lipoprotein electrophoresis determines the amount of proteins made up of protein and fat, called lipoproteins .

    Revisiting The Basics: An Insight Into The Protein Family

    Easy way to remember serum protein electrophoresis : medicalsciece

    Serum proteins are a family of albumin and globulins. Albumin is the major fraction synthesized from human liver endogenously and available through various dietary sources exogenously including egg, meat, pulses, milk etc. Globulins are a group of proteins subclassified into alpha-1, alpha-2, beta-1, beta-2, and gamma globulins based on the electrophoretic mobility . The normal biological interval of serum total proteins in a healthy adult ranges between 6 and 8 g/dl which includes Serum Albumin: 3.5â4.5 g/dl and Globulins: 2.5â3.5 g/dl.

    Figure 2.

    Serum protein family with fractions.

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    What Causes Protein In The Urine During Pregnancy

    Your kidneys are hard at work during pregnancy . They filter the waste products in your blood all while keeping things, like proteins, that your body needs to thrive. After being filtered, the waste is released into your urine.

    If protein makes its way to the urine, thats usually because something isnt functioning quite right in the kidneys.

    Outside of pregnancy, protein in the urine may be temporarily elevated due to:

    • emotional or physical stress
    • exposure to extreme temperatures

    But there are other situations where protein in the urine may be a sign of something more.

    Before 20 weeks of pregnancy, proteinuria is sometimes referred to as chronic proteinuria.

    It may be due to underlying issues with the kidneys or other health conditions that arent necessarily related to your pregnancy, like heart disease. Infections may also elevate the protein levels in your urine and require medical attention.

    After 20 weeks, on the other hand, doctors look more closely at protein as a possible indicator of preeclampsia. This condition is marked by high blood pressure and may cause damage to organs, particularly the liver and kidneys.

    HELLP syndrome is a similar, yet more severe form of preeclampsia that may develop along with preeclampsia or all on its own.

    Without treatment, both conditions may lead to serious complications for both you and baby.

    150 milligrams/day pre-pregnancy to up to 300 mg/d during pregnancy.

    Other risk factors:

    What Is Being Tested

    Proteins are important building blocks of all cells and tissues. They form the structural part of most organs and make up enzymes and some hormones that regulate bodily functions. Protein electrophoresis is a lab method that separates proteins based on their size and electrical charge. Knowing which proteins are present, absent, elevated, or decreased in body fluids such as blood can help diagnose and/or monitor various diseases and conditions.

    Body fluids, such as blood, urine, and cerebrospinal fluid contain many different proteins that have various roles, such as transporting nutrients, removing toxins, and controlling body functions.

    The two major types of proteins are:

    • Albumin is produced in the liver and accounts for about 60% of the protein in the blood.
    • Globulins is a collective term used to refer to proteins other than albumin. With the exception of antibodies and some complement proteins, most of the globulins are also produced in the liver.

    The various proteins in body fluids are subjected to a controlled electric current, fractionating them into a typical pattern of bands or peaks that then can be measured. The proteins are divided into six groups, called prealbumin , albumin, alpha 1, alpha 2, beta, and gamma. The beta fraction may be further divided into beta 1 and beta 2 subgroups.

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    Spep Test Interpretation Of The Result

    The test is performed to detect and monitor kidney and liver diseases, as well as bone marrow and cancer. SPEP test is usually performed if the total protein test result is abnormal. In this case, serum electrophoresis is an extension of the diagnosis. The result of the serum protein electrophoresis test shows the percentage values of the individual protein fractions, as well as their concentration.

    Serum protein electrophoresis interpretation should be performed by the specialist who performed the test.

    Inclusion And Exclusion Criteria

    Serum protein electrophoresis

    This study is part of the national reference interval study thus, both the inclusion and exclusion criteria followed the national reference study protocol. Accordingly, the following eligibility criteria were applied in participant selection.

    Inclusion Criteria

    Apparently healthy individuals aged 18 years and above, who were willing to participate in the study and had lived in the study area for at least 5 years.

    Exclusion Criteria

    Samples showing hemolysis, icterus, or lipemia, or which displayed an abnormality, were excluded. Outlier exclusion was as described in CLSI Guideline EP28A3C.10

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    What Type Of Samples Are Separated In Capillary Electrophoresis

    Capillary zone electrophoresis of proteins The technique separates the proteins into distinct regions and is performed on serum rather than plasma, because the clotting of plasma to form serum removes fibrinogen.

    What is the process of capillary electrophoresis?

    Capillary electrophoresis is a separation technique that separates molecules in an electric field according to size and charge. CE is performed in a small glass tube called a capillary that is filled with an electrolyte solution.

    What Do My Test Results Mean

    Test results may vary depending on your age, gender, health history, and other things. Your test results may be different depending on the lab used. They may not mean you have a problem. Ask your healthcare provider what your test results mean for you.

    Serum proteins can be albumin or globulins. Globulins are divided into alpha-1, alpha-2, beta, and gamma globulins.

    Normal levels are:

    3.8 to 5 grams per deciliter

    Alpha-1

    0.7 to 1.6 g/dL

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    Components Of Serum Protein Electrophoresis

    The pattern of serum protein electrophoresis results depends on the fractions of two major types of protein: albumin and globulins. Albumin, the major protein component of serum, is produced by the liver under normal physiologic conditions. Globulins comprise a much smaller fraction of the total serum protein content. The subsets of these proteins and their relative quantity are the primary focus of the interpretation of serum protein electrophoresis.1,3

    Albumin, the largest peak, lies closest to the positive electrode. The next five components are labeled alpha1, alpha2, beta1, beta2, and gamma. The peaks for these components lie toward the negative electrode, with the gamma peak being closest to that electrode. Figure 1 shows a typical normal pattern for the distribution of proteins as determined by serum protein electrophoresis.

    What Specific Laboratory Diagnostic Tests Are Used For The Diagnosis Of Myeloma

    Figure 3 from Capillary Electrophoresis of Serum Proteins ...

    Serum protein electrophoresis by separation of protein upon an agarose gel can detect the whole Ig in the range of 1 to 5 g/dL, but it only detects increased LC in patients who have very high levels of LC-only myeloma, and it is semi-quantitative. Serum immunofixation electrophoresis is around 10 times more sensitive for Igs and LC, but it is not quantitative. Urine IFE requires concentrated urine samples for the detection of FLCs and can detect low levels of LC. The detection of urine LC by the primitive techniques of boiling and precipitation was one of the earliest descriptions of myeloma disease mollities ossium and its manifestations published in 1847 by Dr. Henry Bence-Jones. Subsequently Korngold and Lapiri raised antisera against the two LC domains. Bence-Jones proteins are urinary FLCs detected by urinary protein electrophoresis and immunofixation.

    Nikhil C. Munshi, Sundar Jagannath, in, 2018

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    What Do My Results Mean

    There are ranges for each hemoglobin type. For example, if your hemoglobin Type F level is higher than normal, it could be a sign you have a form of thalassemia. But knowing test result numbers is just one part of any diagnosis. Your healthcare provider is your best resource for understanding your specific results.

    Quality Assurance In Spe

    Quality assurance in SPE is an essential prerequisite to ensure reliability of an SPE result . There are two major aspects of analytical quality including precision and accuracy .

    Good clinical laboratory practices demand processing of an internal quality control for assessment of precision and external quality assurance /proficiency testing for accuracy assessment. IQC is a material which can be prepared in house or available commercially and is to be processed before a patient sample is taken up for processing.

    The clinical laboratory has its responsibility to select and use an IQC which has a matrix comparable to patient sample, preferably covering the clinical decision point . EQA is an external assessment of the analytical quality wherein the laboratory processes a blinded sample and the results are compared against a reference method and/or against the consensus value of other participant laboratories for that specific sample.

    The laboratory has to hold responsibility in selecting a suitable EQA provider who shall preferably be accredited to ISO 17043. If an EQA program is not available, the laboratories shall participate in exchange of samples with referral laboratories with a similar methodology and a comparable quality of testing standard.

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    What Does Mucus And Blood In Urine Mean

    Mucus in urine can be a sign of bladder cancer, but this isnt common. If mucus in urine is a sign of cancer, it may be accompanied by other symptoms like blood in the urine, abdominal pain, or weight loss.

    What is discharge after peeing?

    What does protein and mucus in urine mean?

    The presence of mucus in the urine in most cases represents a UTI. Protein in urine could be from strenous exercise or even fever.but in cases where there is an uderlying condition, you could have protein from Diabetes, heart disease, or even taking certain drugs can cause you to have protein in the urine.

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    Why Your Doctor May Test For High Protein In Urine

    Investigating paraproteins: Electrophoresis, Immunofixation

    Proteinuria, or protein in the urine, occurs when your kidneys arent functioning normally, allowing protein to leave your body through your urine. Kidneys with normal function filter toxins out of the blood, while keeping nutrients like protein circulating. Having too much protein in your urine can mean that your kidneys are filtering too much protein out of your bloodprotein that your body needs to build muscles and maintain strong bones.

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    Serum Protein Electrophoresis And Immunofixation

    Agarose gel SPEP and immunofixation are the preferred methods of detection of serum M proteins . M proteins appear as a localized band on SPEP.42 After recognition of a localized band suggestive of an M protein on SPEP, immunofixation is necessary for confirmation and to determine the heavy- and light-chain class of the M protein. In addition, immunofixation is more sensitive than SPEP and allows detection of smaller amounts of M protein and should therefore be performed whenever myeloma, amyloidosis, macroglobulinemia, or a related disorder is suggested. The size of the M protein is measured using SPEP. For purposes of clinical trials and monitoring, the M protein is considered to be measurable if it is 1g/dL or more in the serum and or greater than or equal to 200mg/d in the urine.

    Amer Wahed MD, Amitava Dasgupta PhD, DABCC, in, 2015

    Serum Protein Electrophoresis And Cancer

    Some neoplastic diseases cause changes in the concentration of individual protein fractions. Serum protein electrophoresis plays an auxiliary role during oncological diagnostics. This examination, in combination with others, allows to obtain a complete picture about the health of a patient along with the developed health issues. In case of advanced cancer, a decrease in protein is often observed, and thus also the concentration of albumin is lower. SPEP test is most commonly used in the diagnosis and monitoring of myeloma as well as some lymphomas.

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    How Is Protein In The Urine Used As Part Of A Preeclampsia Diagnosis

    Protein in the urine alone doesnt mean you have preeclampsia. In fact, you can have preeclampsia and not have any protein in your urine. Doctors must look at various signs and symptoms to make an accurate diagnosis.

    Again, preeclampsia usually occurs in the second half of pregnancy, after week 20. It can rarely occur earlier or occasionally in the postpartum period.

    Signs and symptoms include:

    • pulmonary edema
    • new vision issues

    Doctors consider a blood pressure reading higher than 140/90 mm Hg to be high during pregnancy. But again a high reading doesnt always mean you have preeclampsia. Your doctor will look at the trend in your numbers compared to your baseline to help with diagnosis.

    Testing might include:

    • Blood tests to evaluate your liver function, kidney function, and the number of platelets in your blood.
    • 24-hour urine collection to observe protein in your urine throughout an entire day.
    • Ultrasound to monitor your babys development and the amount of amniotic fluid in your uterus.
    • Nonstress tests or biophysical profiles to evaluate your babys health status. These can reveal babys heart rate with relation to their movements and their breathing and muscle tone.

    Serum Protein Electrophoresis When Should It Be Done

    Quality controls for capillary and native serum protein electrophoresis

    SPEP test verifies the results of other laboratory tests, as a part of diagnostics of inflammation, autoimmune diseases, and monitoring of blood proliferative diseases . This test is performed to obtain information about how the disease effects on the protein production in the patients body. Usually, additional tests are required to identify the immediate cause of the disease.

    The doctor may refer a patient to serum protein electrophoresis in case of such symptoms:

    • Recurring infections, herpes, thrush

    The basis for performing SPEP tests are symptoms that may indicate neoplastic diseases, blood proliferative diseases, autoimmune diseases, chronic inflammation, kidney diseases , liver damage, chronic infections.

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    What Is The Electrophoresis Test

    Electrophoresis is a lab technique used to separate groups of proteins in blood serum. This allows them to be measured and analyzed individually. It involves exposing serum placed in a special type of gel to an electric current. This causes the different proteins to move and group together. The proteins create separate bands on the gel, which are then analyzed by the laboratory.

    Sensitivity And Specificity Of The Urine Proteincreatinine Ratio And The Urinalysis For Predicting Severe Proteinuria

    Sensitivities, specificities and positive and negative predictive values were calculated for many cutoffs of the urine proteincreatinine ratio and each cutoff of the urinalysis to demonstrate the accuracy of each test for predicting 5000 mg proteinuria per 24-h period . Only three patients in our study had proteinuria 5000 mg of protein. As a screening test for identifying patients who may have severe proteinuria, the urine proteincreatinine ratio and the urinalysis are very good. They also both have good specificity, in particular the urine proteincreatinine ratio 5.0 and the urinalysis 3+. In fact, to predict severe proteinuria it appears that the urine proteincreatinine ratio is unlikely to add utility to the urinalysis alone. Caution should be used in using spot urine studies rather than 24-h urine collections to make a diagnosis of severe proteinuria because this analysis is limited by the relatively few number of patients with severe proteinuria in this study and, therefore, the inability to accurately describe a range.

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