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CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(04): 518-523
DOI: 10.1055/s-0043-1768684
Original Article

Understanding the Constraints and Optimization of Serum Immunofixation Electrophoresis and Serum Free Light Chains for Detecting Monoclonal Proteins: A Single-Center Experience

Malvika Shastri 
1   Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Pankaj Malhotra
2   Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Harvinder Kaur
3   Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Ritu Aggarwal
3   Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Introduction Serum immunofixation electrophoresis (SIFE) and serum free light chain (SFLC) assay are imperative investigations in diagnosis and follow-up of multiple myeloma (MM). SFLC assays are reported to have higher sensitivity than SIFE. However, discrepancies have been reported between them. The current study was aimed at assessing concordance and discordance between SIFE and SFLC results in MM.

Methods A total of 450 observations of both SIFE and SFLC were obtained from treatment-naive and follow-up MM patients.

Results One hundred and twenty-nine (28.7%) values were observed as discordant, that is, positive SIFE with normal SFLC ratio or negative SIFE with abnormal SFLC ratio (p-value < 0.00001). Proportion of discordance was higher in SIFE positive-SFLC normal cases than SIFE negative-SFLC abnormal cases. Discordance was more frequent in follow-up cases.

Conclusion Negative SFLC alone may not be reliable for MM follow-up. Algorithm may be based on SFLC measurements on each follow-up till attainment of normal SFLC ratio. Once SFLC normalizes, follow-up may be done with SIFE. If SIFE is positive, further follow-up with SIFE may be initiated.

Keywords

serum immunofixation - serum free light chain - multiple myeloma - concordance - discordance

Authors' Contribution

All authors contributed equally in the study, conception, acquition of data for the research.




Publication History

Received: 27 December 2022

Accepted: 13 March 2023

Article published online:
05 May 2023

© 2023. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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