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Serum Protein Electrophoresis 

  • Author: Sherilyn Alvaran Tuazon, MD; Chief Editor: Eric B Staros, MD  more...
 
Updated: Sep 05, 2014
 

Reference Range

Serum protein electrophoresis (SPEP) is an easy, inexpensive method of separating proteins based on their net charge, size, and shape. The 2 major types of protein present in the serum are albumin and the globulin proteins. Albumin is the major protein component of serum and represents the largest peak that lies closest to the positive electrode.[1] Globulins comprise a much smaller fraction of the total serum protein but represent the primary focus of interpretation of serum protein electrophoresis. Five globulin categories are represented: alpha-1, alpha-2, beta-1, beta-2, and gamma, with the gamma fraction being closest to the negative electrode.

The reference range for serum protein electrophoresis is as follows:

  • Albumin: 3.3-5.7 g/dL
  • a- 1: 0.1-0.4 g/dL
  • a- 2: 0.3-0.9 g/dL
  • b- 2: 0.7-1.5 g/dL
  • gamma: 0.5-1.4 g/dL

The reference range may vary depending on the laboratory performing the test.

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Interpretation

Various disease states or conditions alter the pattern of proteins in electrophoresis (see Table 1 below).

Table 1. Serum Protein Fractions and Conditions Associated with an Increased or Decreased Level (Open Table in a new window)

Serum Protein Fraction Increased Decreased
Albumin Severe dehydration Malnutrition, cachexia, liver disease, nephrotic syndrome, protein-losing enteropathies, severe burns
Alpha-1 Inflammatory states, pregnancy Alpha-1 antitrypsin deficiency
Alpha-2 Inflammatory states, nephrotic syndrome, oral contraceptive use, steroid use, hyperthyroidism Hemolysis, liver disease
Beta Hyperlipidemia, iron-deficiency anemia Hypo-B-lipoproteinemia, malnutrition
Gamma Polyclonal and Monoclonal Gammopathies Agammaglobulinemia, hypogammaglobulinemia

 

Monoclonal gammopathy

A dense narrow band that is composed of a single class of immunoglobulins secreted by an abnormally expanded clone of plasma cells is known as M-protein (paraprotein, monoclonal protein or M-component).[2] An M-protein usually presents as a single narrow peak, resembling a "church spire," in the gamma, beta, or alpha-2 region of the densitometer tracing, or as a dense, discrete band on the agarose gel (see image below).

Monoclonal pattern serum protein electrophoresis ( Monoclonal pattern serum protein electrophoresis (SPEP).

The monoclonal antibody must be present at a concentration of at least 0.5 g/dL in order to be accurately identified using SPEP. This corresponds to approximately 109 antibody-producing cells.[3] Plasma cell disorders are typically associated with the presence of an M-protein (see Table 2 below). In addition, an M component may be detected in other lymphoid malignancies like chronic lymphocytic leukemia, any B- or T- cell lymphomas, breast cancer, colon cancer, cirrhosis, sarcoidosis, and other autoimmune disorders.

Conditions associated with a monoclonal increase in the gamma region are as follows:

  • Smoldering myeloma
  • Monoclonal gammopathy of undetermined significance (MGUS)
  • Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS syndrome)
  • Solitary plasmacytoma
  • Castleman disease
  • AL amyloidosis
  • Heavy chain deposition disease
  • Light chain deposition disease

Polyclonal gammopathy

Infectious, Inflammatory or various reactive processes may be associated with a broad-based peak or band in the gamma region (Figure 4). This pattern suggests a polyclonal increase in immunoglobulins. Liver disease, autoimmune disease, chronic viral or bacterial infections and various malignancies may cause a polyclonal rise in the gamma fraction (see Table 2 below).

Polyclonal pattern serum protein electrophoresis ( Polyclonal pattern serum protein electrophoresis (SPEP).

Table 2. Diseases Associated with a Polyclonal Gammopathy (Open Table in a new window)

Condition Examples
Liver disease Cirrhosis, autoimmune or viral hepatitis
Connective tissue diseases Rheumatoid arthritis, systemic lupus erythematosus, scleroderma, Sjogren syndrome
Infection Bacterial: osteomyelitis, endocarditis, osteomyelitis



Viral: HIV/AIDS, hepatitis C, Epstein-Barr virus



Hematologic disorders/malignancies Non-Hodgkin lymphoma, chronic lymphocytic leukemia, thalassemia, sickle cell anemia
Nonhematologic malignancies Lung, ovarian, gastric malignancies, hepatocellular carcinoma

Considerations

The presence of an M-protein may be missed if the level is too small to be detected using SPEP. In cases where a high suspicion for a clonal plasma cell disorder is high, more sensitive tests such as a serum immunofixation or free light chain assay should be performed. In addition, when either alpha-1 antitrypsin deficiency or immunoglobulin deficiency, specific quantitation is indicated as SPEP is insensitive in these cases.

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Collection and Panels

Specimen: Serum

Container: Red-top tube, serum separator tube (SST; see the image below)

Photograph of a red-top and serum-separator (SST) Photograph of a red-top and serum-separator (SST) tubes. (Original photo by Rapeepat Lekkham, MD.)

Collection method: Routine venipuncture

Blood must first be collected in a red top or serum separator tube. Serum, which is the fluid portion of blood after it has clotted, is placed on a specific medium and exposed to an electric current to separate its protein components. Two methods are usually used namely, agarose gel electrophoresis, or less commonly, capillary zone electrophoresis.[2, 4, 5, 6] In both methods, proteins are classified by their final position into five general regions:

Albumin

Albumin represents the highest peak in serum protein electrophoresis, usually seen as a single, tall band. Occasionally, however two equally staining bands, referred to as bisalbuminemia or a widely staining band may be seen, which both represent normal variations.[7] Common conditions associated with decreased albumin include malnutrition, cirrhosis and nephrotic syndrome. Dehydration, on the other hand, causes a high albumin.

An area between albumin and the alpha-1 band is called the albumin-alpha-1 interzone. Even staining in this zone is caused by alpha-1 lipoprotein (High-density lipoprotein or HDL). An increase is usually seen in alcoholic liver disease, pregnancy and during puberty. A sharp band may also be seen in those with hepatocellular carcinoma as a result of elevated alpha-fetoprotein (AFP).[1]

Alpha zone

The alpha-1 fraction includes alpha-1 antitrypsin, transcortin, and thyroid-binding globulin.[7] Alpha-2 fraction is comprised of ceruloplasmin, alpha-2 macroglobulin, and haptoglobin. Both alpha-1 and 2 represent the acute phase reactants; hence, malignancy, infection or any inflammatory condition can cause their elevation. A relative increase in alpha-2 fraction may be seen in nephrotic syndrome due to the relative larger size of the proteins and the inability to pass through the glomeruli. A decrease in alpha-1 component may be seen in alpha-1 antitrypsin deficiency and a decrease in alpha-2 component may be seen in hemolytic anemia due to decreased haptoglobin levels.

Beta zone

The beta zone consist of beta-1 and beta-2 but is often represented a graphically as a single band. Beta-1 consists mostly of transferrin, and is increased in conditions such as iron-deficiency anemia, pregnancy and estrogen therapy. B-lipoprotein and C3 complement are included in the B-2 component.[3] IgA, IgM, and sometimes IgG can occasionally be identified in the beta fraction as well.

Gamma zone

Immunoglobulins mainly comprise this area including IgG, IgA, IgM, IgD and IgE. Agammaglobulinemia and hypogammaglobulinemia syndromes such as IgA deficiency are associated with a decrease in this area. Various inflammatory, autoimmune and hematologic, and non-hematologic diseases are associated with an increased gamma peak. However, a homogenous, spike-like increase in the gamma region is of special interest as it may represent an abnormal expansion of immunoglobulin-producing plasma cells.

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Background

Description

Serum protein electrophoresis (SPEP) is an easy, inexpensive method of separating proteins based on their net charge, size, and shape. The 2 major types of protein present in the serum are albumin and the globulin proteins. Albumin is the major protein component of serum and represents the largest peak that lies closest to the positive electrode.[1] Globulins comprise a much smaller fraction of the total serum protein but represent the primary focus of interpretation of serum protein electrophoresis. Five globulin categories are represented: alpha-1, alpha-2, beta-1, beta-2, and gamma, with the gamma fraction being closest to the negative electrode (see the image below).

Normal serum protein electrophoresis diagram with Normal serum protein electrophoresis diagram with legend of different zones.

Indications/Applications

Serum protein electrophoresis is generally considered in any patient with an elevated total protein, especially those with elevated globulin level relative to albumin, or any signs and symptoms suggestive of an underlying plasma cell disorder such as multiple myeloma, Waldenstrom’s macroglobulinemia, or primary amyloidosis.[3] These include any of the following:

  • Unexplained anemia, back pain, bone pain, fatigue
  • Unexplained pathologic fracture or lytic lesions
  • Unexplained peripheral neuropathy
  • Hypercalcemia secondary to possible malignancy
  • Hypergammaglobulinemia
  • Rouleaux formation noted on peripheral blood smear
  • Renal insufficiency with bland urine sediment
  • Unexplained proteinuria
  • Bence Jones proteinuria
  • Recurrent infections
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Contributor Information and Disclosures
Author

Sherilyn Alvaran Tuazon, MD Clinical Instructor, Division of Hematologic Malignancies, Department of Medical Oncology, Jefferson Medical College of Thomas Jefferson University; Hospitalist, Bone Marrow Transplant Unit, Medical Staff, Urgent Care Clinic, Thomas Jefferson University Hospital

Sherilyn Alvaran Tuazon, MD is a member of the following medical societies: Philippine Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Anthony P Scarpaci, MD Attending Physician, Medical Oncology/Hematology Associates, Albert Einstein Health Network

Disclosure: Nothing to disclose.

Chief Editor

Eric B Staros, MD Associate Professor of Pathology, St Louis University School of Medicine; Director of Clinical Laboratories, Director of Cytopathology, Department of Pathology, St Louis University Hospital

Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology

Disclosure: Nothing to disclose.

References
  1. Dupree, Shandi. Electrophoresis (Methods in Biochemistry). 1st edition. New Delhi, India: World Technologies, Publishing; 2012 Jan 1.

  2. Cho SY, You E, La Jeon Y, Lee HJ, Park TS. Masked monoclonal gammopathy in capillary electrophoresis. Clin Lab. 2014. 60(7):1233-6. [Medline].

  3. Munshi NC, Longo DL, Anderson KC. Plasma cell disorders: Harrison’s Principles of Internal Medicine. 18th ed. The McGraw-Hill Companies; 2005.

  4. Huang RS, Dasgupta A, Nguyen AN, Wahed A. Inability to Measure M-Protein With Capillary Zone Electrophoresis (CAPPILLARYS 2) in Tracings With NonDiscernable Peaks. J Clin Lab Anal. 2014 Aug 17. [Medline].

  5. Tan L, Zheng X, Chen L, Wang Y. Quality testing of human albumin by capillary electrophoresis using thermally crosslinked poly(vinyl pyrrolidone)-coated fused-silica capillary. J Sep Sci. 2014 Aug 11. [Medline].

  6. Falcone M. An attempt to run urinary protein electrophoresis through capillary technique. Electrophoresis. 2014 Jul 29. [Medline].

  7. O'Connell TX, Horita TJ, Kasravi B. Understanding and interpreting serum protein electrophoresis. Am Fam Physician. 2005 Jan 1. 71(1):105-12. [Medline].

  8. Bossuyt X. Advances in serum protein electrophoresis. Adv Clin Chem. 2006. 42:43-80. [Medline].

  9. Vavricka SR, Burri E, Beglinger C, Degen L, Manz M. Serum protein electrophoresis: an underused but very useful test. Digestion. 2009. 79(4):203-10. [Medline].

 
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Photograph of a red-top and serum-separator (SST) tubes. (Original photo by Rapeepat Lekkham, MD.)
Normal serum protein electrophoresis diagram with legend of different zones.
Polyclonal pattern serum protein electrophoresis (SPEP).
Monoclonal pattern serum protein electrophoresis (SPEP).
Table 1. Serum Protein Fractions and Conditions Associated with an Increased or Decreased Level
Serum Protein Fraction Increased Decreased
Albumin Severe dehydration Malnutrition, cachexia, liver disease, nephrotic syndrome, protein-losing enteropathies, severe burns
Alpha-1 Inflammatory states, pregnancy Alpha-1 antitrypsin deficiency
Alpha-2 Inflammatory states, nephrotic syndrome, oral contraceptive use, steroid use, hyperthyroidism Hemolysis, liver disease
Beta Hyperlipidemia, iron-deficiency anemia Hypo-B-lipoproteinemia, malnutrition
Gamma Polyclonal and Monoclonal Gammopathies Agammaglobulinemia, hypogammaglobulinemia
Table 2. Diseases Associated with a Polyclonal Gammopathy
Condition Examples
Liver disease Cirrhosis, autoimmune or viral hepatitis
Connective tissue diseases Rheumatoid arthritis, systemic lupus erythematosus, scleroderma, Sjogren syndrome
Infection Bacterial: osteomyelitis, endocarditis, osteomyelitis



Viral: HIV/AIDS, hepatitis C, Epstein-Barr virus



Hematologic disorders/malignancies Non-Hodgkin lymphoma, chronic lymphocytic leukemia, thalassemia, sickle cell anemia
Nonhematologic malignancies Lung, ovarian, gastric malignancies, hepatocellular carcinoma
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