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Hey there,
Thank you for reading this newsletter. I hope you are deriving value from it. In the previous editions, I have written about basics of hematology including role of nutrients in blood formation, role of the different white blood cells and also written about venous thromboembolism and conditions that predispose to blood clots.
I’d like to now pivot to talking about monoclonal gammopathies. As a hematologist, I see atleast 2, if not more, new patient referrals per week for some form of monoclonal gammopathies, whether its MGUS or smoldering myeloma or multiple myeloma or waldenstrom’s.
Most of these referrals get triggered when, on a routine blood draw, someone is noted to have elevated total protein and that leads the provider to ordering a serum protein electrophoresis.
In the next few newsletters, I will talk about the various monoclonal gammopathies, clinical features and basic overview of treatment.
Let’s dive a little deeper into the testing-
Serum Protein Electrophoresis (SPEP) is a laboratory test that separates and measures the different proteins in your blood serum to help diagnose various diseases.
How It Works
The test uses an electric field to separate blood proteins based on their size, shape, and electrical charge. As proteins migrate through a gel medium, they form distinct bands or zones that can be measured and analyzed.
The Five Main Protein Fractions
SPEP typically identifies five protein bands:
1. Albumin (normally 55-65% of total protein) - Made by the liver, maintains fluid balance and transports substances
2. Alpha-1 globulins - Includes acute phase proteins like alpha-1 antitrypsin
3. Alpha-2 globulins - Contains haptoglobin and other acute phase reactants
4. Beta globulins - Includes transferrin (iron transport) and complement proteins
5. Gamma globulins - Primarily immunoglobulins (antibodies)
What It Diagnoses
SPEP is particularly useful for detecting:
Multiple myeloma and other plasma cell disorders - Shows characteristic "M-spike" (monoclonal protein peak)
Chronic infections or inflammation - Elevated gamma globulins
Liver disease - Decreased albumin, altered globulins
Kidney disease - Protein loss patterns
Immune deficiencies - Low gamma globulins
Alpha-1 antitrypsin deficiency - Decreased alpha-1 band
A hematology referral gets triggered when there is an M-spike (like below), typically in the gamma region (immunoglobulin region) of the serum protein electrophoresis.
This is what the SPEP would look like if someone had an M-spike
Credit: International Myeloma Foundation
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Disclaimer: The content in this newsletter is for educational purposes only and should not be considered medical advice. Subscription to this newsletter does not establish a doctor-patient relationship. Always consult your physician with specific questions regarding your health