Waldenström's macroglobulinemia electrophoresis and immunofixation

Waldenström's macroglobulinemia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2] Roukoz A. Karam, M.D.[3]

Overview

Serum protein electrophoresis and immunofixation are important for the diagnosis of Waldenström's macroglobulinemia and shows sharp, narrow spike and dense band of monoclonal IgM paraprotein. CSF flow cytometry, protein electrophoresis and immunofixation are done for the diagnosis of Bing-Neel syndrome and shows a lambda light chain-restricted population of B-cells consistent with a CD5+ CD10+ B-cell lymphoma.

Electrophoresis and Immunofixation

• Serum protein electrophoresis is important for the diagnosis of Waldenström's macroglobulinemia.
• Findings on an electrophoresis diagnostic of Waldenström's macroglobulinemia include:
  • Sharp, narrow spike of monoclonal IgM protein
  • Dense band of monoclonal IgM protein
  • The paraprotein can be of any size
• Serum immunofixation is important for the diagnosis of Waldenström's macroglobulinemia. It helps in confirming the presence of a monoclonal protein, in addition to determining its type.

Serum immunofixation electrophoresis. (A) There is a slightly dense band with IgM, kappa antisera, suggestive of monoclonal gammopathy (B) After the treatment, a dense band with IgM was disappeared.Source: Kim YL. et al, Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea.

CSF flow cytometry, protein electrophoresis and immunofixation for diagnosis of Bing-Neel syndrome

• For diagnosing Bing-Neel syndrome, after lumbar puncture, CSF flow cytometry is done which shows a lambda light chain-restricted population of B-cells consistent with a CD5+ CD10+ B-cell lymphoma.
• Furthermore, protein electrophoresis and immunofixation should be done for the detection and classification of a monoclonal protein as well as molecular diagnostic testing for immunoglobulin gene rearrangement and mutated MYD88.

Stereostactic brain biopsy showing diffuse infiltration of atypical plasmacytoid lymphocytes into the dural fibrous tissue (A) Hematoxylin & eosin (original magnification ×200); (B) Positive immunohistochemical staining for CD20 (original magnification ×40). Source: Kim HD. et al, Department of Internal Medicine, Yeoungnam University College of Medicine, Daegu, Korea.

Plasmacytoid cells found on cytospin of the cerebrospinal fluid confirming cellular infiltration of the central nervous system.Source: Halperin D. et al, Whipps Cross Hospital, London E11 1NR, UK.