Waldenström's macroglobulinemia electrophoresis and immunofixation: Difference between revisions
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{{Waldenström's macroglobulinemia}} | {{Waldenström's macroglobulinemia}} | ||
{{CMG}}; {{AE}} {{RAK}} | {{CMG}}; {{AE}}{{S.M.}} {{RAK}} | ||
==Overview== | ==Overview== | ||
[[Protein electrophoresis|Serum protein electrophoresis]] and [[immunofixation]] are important for the diagnosis of Waldenström's macroglobulinemia. | [[Protein electrophoresis|Serum protein electrophoresis]] and [[immunofixation]] are important for the [[diagnosis]] of [[Waldenström's macroglobulinemia]] and shows sharp, narrow spike and [[dense]] band of [[Monoclonal antibodies|monoclonal]] [[Immunoglobulin M|IgM]] [[paraprotein]]. [[CSF]] [[flow cytometry]], [[protein electrophoresis]] and [[immunofixation]] are [[done]] for the [[diagnosis]] of [[Bing-Neel syndrome]] and shows a [[Lambda (anatomy)|lambda]] [[light chain]]-[[Restriction|restricted]] [[population]] of [[B-cells]] consistent with a [[CD5|CD5+]] [[CD10|CD10+]] [[B-cell lymphoma]]. | ||
==Electrophoresis and Immunofixation== | ==Electrophoresis and Immunofixation== | ||
[[Serum protein electrophoresis]] is important for the diagnosis of Waldenström's macroglobulinemia. | *[[Serum protein electrophoresis]] is important for the [[diagnosis]] of [[Waldenström's macroglobulinemia]]. | ||
*Findings on an [[electrophoresis]] [[diagnostic]] of [[Waldenström's macroglobulinemia]] include:<ref name="pmid1872571">{{cite journal| author=Riches PG, Sheldon J, Smith AM, Hobbs JR| title=Overestimation of monoclonal immunoglobulin by immunochemical methods. | journal=Ann Clin Biochem | year= 1991 | volume= 28 ( Pt 3) | issue= | pages= 253-9 | pmid=1872571 | doi=10.1177/000456329102800310 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1872571 }} </ref> | |||
**Sharp, narrow [[Spike sorting|spike]] of [[Monoclonal antibodies|monoclonal]] [[IgM]] [[protein]] | |||
**[[Dense]] band of [[Monoclonal antibody|monoclonal]] [[Immunoglobulin M|IgM]] [[protein]] | |||
**The [[paraprotein]] can be of any [[Size consistency|size]] | |||
* [[Serum]] [[immunofixation]] is important for the [[diagnosis]] of [[Waldenström's macroglobulinemia]]. It helps in confirming the presence of a [[Monoclonal|monoclonal protein]], in addition to determining its type.<ref name="pmid1872571">{{cite journal| author=Riches PG, Sheldon J, Smith AM, Hobbs JR| title=Overestimation of monoclonal immunoglobulin by immunochemical methods. | journal=Ann Clin Biochem | year= 1991 | volume= 28 ( Pt 3) | issue= | pages= 253-9 | pmid=1872571 | doi=10.1177/000456329102800310 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1872571 }} </ref> | |||
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[[File:Serum immunofixation electrophoresis.png|thumb|250px|none| 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.[https://openi.nlm.nih.gov/detailedresult.php?img=PMC3102879_jkms-26-824-g002&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=41 Source: Kim YL. et al, Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea.]]] | |||
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===CSF flow cytometry, protein electrophoresis and immunofixation for diagnosis of Bing-Neel syndrome=== | |||
* For [[Diagnose|diagnosing]] [[Bing–Neel syndrome|Bing-Neel syndrome]], after [[lumbar puncture]], [[CSF]] [[flow cytometry]] is [[done]] which shows a [[Lambda (anatomy)|lambda]] [[light chain]]-[[Restriction|restricted]] [[population]] of [[B-cells]] consistent with a [[CD5|CD5+]] [[CD10|CD10+]] [[B-cell lymphoma]]. | |||
* Furthermore, [[protein electrophoresis]] and [[immunofixation]] should be [[done]] for the [[Detection theory|detection]] and [[classification]] of a [[Monoclonal antibody|monoclonal]] [[protein]] as well as [[molecular]] [[diagnostic testing]] for [[immunoglobulin]] [[gene]] [[rearrangement]] and [[mutated]] [[MYD88]].<ref name="pmid30228918">{{cite journal| author=O'Neil DS, Francescone MA, Khan K, Bachir A, O'Connor OA, Sawas A| title=A Case of Bing-Neel Syndrome Successfully Treated with Ibrutinib. | journal=Case Rep Hematol | year= 2018 | volume= 2018 | issue= | pages= 8573105 | pmid=30228918 | doi=10.1155/2018/8573105 | pmc=6136466 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30228918 }} </ref><ref name="pmid27758817">{{cite journal| author=Minnema MC, Kimby E, D'Sa S, Fornecker LM, Poulain S, Snijders TJ et al.| title=Guideline for the diagnosis, treatment and response criteria for Bing-Neel syndrome. | journal=Haematologica | year= 2017 | volume= 102 | issue= 1 | pages= 43-51 | pmid=27758817 | doi=10.3324/haematol.2016.147728 | pmc=5210231 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27758817 }} </ref><ref name="pmid30279255">{{cite journal| author=Tallant A, Selig D, Wanko SO, Roswarski J| title=First-line ibrutinib for Bing-Neel syndrome. | journal=BMJ Case Rep | year= 2018 | volume= 2018 | issue= | pages= | pmid=30279255 | doi=10.1136/bcr-2018-226102 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30279255 }} </ref> | |||
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[[File:Brain biopsy.png|thumb|250px|none| 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). [https://openi.nlm.nih.gov/detailedresult.php?img=PMC2694623_jkms-22-1079-g002&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=29 Source: Kim HD. et al, Department of Internal Medicine, Yeoungnam University College of Medicine, Daegu, Korea.]]] | |||
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[[File:Csf plasmacytoid cells.png|thumb|250px|none| Plasmacytoid cells found on cytospin of the cerebrospinal fluid confirming cellular infiltration of the central nervous system.[https://openi.nlm.nih.gov/detailedresult.php?img=PMC4837273_CRIHEM2016-3931709.004&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=71 Source: Halperin D. et al, Whipps Cross Hospital, London E11 1NR, UK.]]] | |||
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==References== | ==References== | ||
Latest revision as of 18:54, 15 August 2019
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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:[1]
- 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.[1]
 |
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.[2][3][4]
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References
- ↑ 1.0 1.1 Riches PG, Sheldon J, Smith AM, Hobbs JR (1991). "Overestimation of monoclonal immunoglobulin by immunochemical methods". Ann Clin Biochem. 28 ( Pt 3): 253–9. doi:10.1177/000456329102800310. PMID 1872571.
- ↑ O'Neil DS, Francescone MA, Khan K, Bachir A, O'Connor OA, Sawas A (2018). "A Case of Bing-Neel Syndrome Successfully Treated with Ibrutinib". Case Rep Hematol. 2018: 8573105. doi:10.1155/2018/8573105. PMC 6136466. PMID 30228918.
- ↑ Minnema MC, Kimby E, D'Sa S, Fornecker LM, Poulain S, Snijders TJ; et al. (2017). "Guideline for the diagnosis, treatment and response criteria for Bing-Neel syndrome". Haematologica. 102 (1): 43–51. doi:10.3324/haematol.2016.147728. PMC 5210231. PMID 27758817.
- ↑ Tallant A, Selig D, Wanko SO, Roswarski J (2018). "First-line ibrutinib for Bing-Neel syndrome". BMJ Case Rep. 2018. doi:10.1136/bcr-2018-226102. PMID 30279255.