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Section 3 of 6 · Open sections

Required section · Section 3 of 6

Methods, look-alikes, and confirmation

Agarose gel electrophoresis produces stained bands read by densitometry. Capillary zone electrophoresis (CZE) produces a UV-absorbance electropherogram in a liquid-filled capillary. Both separate the five major fractions, but CZE often resolves beta into beta-1 and beta-2, so values are not numerically interchangeable.

A restricted feature on SPEP is not immunotyping. Immunofixation electrophoresis (IFE) uses heavy-chain and light-chain antisera to identify an immunoglobulin class and kappa or lambda type. Serum free light chain (sFLC) testing and the kappa/lambda ratio complement SPEP and serum IFE because a negative SPEP does not exclude a small, oligosecretory, or light-chain-only presentation.

Check look-alikes before treating a peak as biologic. In incompletely clotted plasma, residual fibrinogen can migrate in the fast-gamma or beta-gamma region. Hemolysis releases hemoglobin, which forms a hemoglobin-haptoglobin complex in the alpha-2 region. Recent iodinated contrast can create a UV-detected CZE feature near beta. An unexplained peak starts with specimen type, integrity, and interference review, not a disease label.

Illustrative drawing — this picture was drawn rather than captured.

Four traces compare broad polyclonal gamma rise, a coral narrow restricted peak, low gamma fraction, and mustard beta-gamma bridging; captions explain the visible shape.
Figure 1Shape atlas for common serum protein pattern classes and a beta-gamma look-alike.

Knowledge checks

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Knowledge check 1

Which follow-up identifies the heavy-chain class and kappa or lambda type of a monoclonal protein?

Choose one option.

Knowledge check 2

Which observations should prompt an interference review before a peak is released as biologic?

Choose at least 2 options.

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