Detecting or monitoring of monoclonal gammopathies and immune

deficiencies

The gamma-globulin band as seen in conventional serum protein

electrophoresis consists of 5 immunoglobulins. In normal serum,

about 5% is IgM.

Elevations of IgM may be due to polyclonal immunoglobulin production.  

Monoclonal elevations of IgM occur in macroglobulinemia.

Monoclonal gammopathies of all types may lead to a spike in the

gamma-globulin zone seen on serum protein electrophoresis.

Decreased immunoglobulin levels are found in patients with congenital

deficiencies.

Males

      0-4 months:  14-142 mg/dL

      5-8 months:  24-167 mg/dL

      9-23 months:  35-200 mg/dL

      2-3 years:  41-200 mg/dL

      4-17 years:  47-200 mg/dL

      > or = 18 years:  50-300 mg/dL

Females

      0-4 months:  14-142 mg/dL

      5-8 months:  24-167 mg/dL

      9-23 months:  35-242 mg/dL

      2-3 years:  41-242 mg/dL

      4-17 years:  56-242 mg/dL

      > or =18 years:  50-300 mg/dL

Increased serum immunoglobulin concentrations occur due to

polyclonal or oligoclonal immunoglobulin proliferation in hepatic

disease (hepatitis, liver cirrhosis), connective tissue diseases, acute

and chronic infections, as well as in the cord blood of neonates with

intrauterine and perinatal infections.

Elevation of IgM may occur in monoclonal gammopathies such as

macroglobulinemia, primary systemic amyloidosis, monoclonal gamm-

opathy of undetermined significance, and related disorders.

Decreased levels are found in patients with primary or secondary

immune deficiencies.

Electrophoresis is usually required to interpret an elevated

immunoglobulin class as polyclonal versus monoclonal.

Immunofixation is usually required to characterize

a monoclonal protein.

If there is a discrete M-peak, the monoclonal protein can be

monitored with quantitative immunoglobulins. If immunoglobulin

quantitation is used to monitor the size of a monoclonal protein

which is contained in a back-ground of polyclonal immunoglobulins,

however, changes in the immunoglobulin quantitation may reflect

changes in the background immunoglobulins, and serum protein

electrophoresis should therefore be used to monitor the monoclonal

protein.

1.   Webster ADB:  Laboratory Investigation of primary deficiency

      of the lymphoid system. In Clinics in Immunology and Allergy.

      Vol. 5. 3rd edition. Philadelphia, WB Saunders Company, 1985,

      pp 447-468

2.   Pinching AJ:  Laboratory investigation of secondary immunodeficiency.

      In Clinics in Immunology and Allergy. Vol. 5. Third edition. Philadelphia,

      WB Saunders Company, 1985, pp 469-490

3.   Dispenzieri A, Gertz MA, Kyle RA:  Distribution of diseases associated

      with moderate polyclonal gammopathy in patients seen at Mayo

      Clinic during 1991. Blood 1997;90:353

4.   Kyle RA, Greipp PR:  The laboratory investigation of monoclonal

      gammopathies. Mayo Clin Proc 1978;53:719-739

5.   Ballow M, O'Neil KM:  Approach to the patient with recurrent

      infections.  In Allergy:  Principles and Practice. Vol. 2. Fourth

      edition. Edited by E Middleton Jr, CE Reed, EF Ellis, et al. St.

      Louis, MO, Mosby-Year Book, Inc., 1993, pp 1027-1058

6.   Kyle RA:  Detection of quantitation of monoclonal proteins. Clin

      Immunol Newsletter 1990;10:84-86