Referral for Abnormal Protein Electrophoresis
Introduction to Abnormal Protein Electrophoresis
- Patients with abnormal protein electrophoresis should be referred to a hematologist/oncologist for evaluation and management, as these findings may indicate multiple myeloma or other plasma cell disorders requiring specialized care, according to the National Comprehensive Cancer Network 1, 2
Diagnostic Pathway
- Initial abnormal serum protein electrophoresis (SPEP) should be followed by serum immunofixation electrophoresis (SIFE) to identify the type of abnormal antibodies, quantitative immunoglobulin levels (IgG, IgA, and IgM), serum free light chain (FLC) assay, and 24-hour urine collection for total protein, urine protein electrophoresis (UPEP), and urine immunofixation electrophoresis (UIFE), as recommended by the National Comprehensive Cancer Network 1, 2, 3
- If monoclonal protein is detected, additional testing should include complete blood count (CBC) with differential, blood chemistry including calcium, creatinine, and LDH, beta-2 microglobulin, bone marrow aspiration and biopsy with immunohistochemical staining, skeletal survey or advanced imaging, and chromosomal analysis using cytogenetics and FISH, according to the National Comprehensive Cancer Network 1, 2, 3, 4
Specialist Referral
- Any detected monoclonal protein (M-protein) on SPEP or IFE, abnormal free light chain ratio, or unexplained anemia, renal dysfunction, hypercalcemia, or bone lesions with abnormal protein studies should be referred to a hematologist/oncologist, as recommended by the National Comprehensive Cancer Network 1, 2, 3
- Urgent referral (within 1-2 weeks) is recommended for patients with significant M-protein spike, accompanying symptoms, anemia, renal dysfunction, or hypercalcemia, according to the National Comprehensive Cancer Network 1, 2
- Nonsecretory myeloma may have neither serum nor urine M-proteins but still requires hematology evaluation, as noted by the National Comprehensive Cancer Network 1, 3