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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 immunoglobulin M (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.
0-<5 months: 26-122 mg/dL
5-<9 months: 32-132 mg/dL
9-<15 months: 40-143 mg/dL
15-<24 months: 46-152 mg/dL
2-<4 years: 37-184 mg/dL
4-<7 years: 37-224 mg/dL
7-<10 years: 38-251 mg/dL
10-<13 years: 41-255 mg/dL
13-<16 years: 45-244 mg/dL
16-<18 years: 49-201 mg/dL
> or =18 years: 37-286 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 immunoglobulin M may occur in monoclonal gammopathies such as macroglobulinemia, primary systemic amyloidosis, monoclonal gammopathy 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.
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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
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