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Can A Serum Immunofixation Test Differentiate Between Multiple Myeloma And Globulin Abnormalities?

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Posted on Tue, 28 Jun 2016
Question: Hello, I have 3 inter-related questions. Background:
I believe I will be taking a serum immunofixation test in the near future to investigate a possible monoclonal protein disease, but I have been vaccinated against rabies several times (I've had unbelievably bad luck accidentally having encounters with bats), most recently in December 2015 and I'm wondering if the vaccination could potentially obscure the results and point toward a plasma cell disease even if one isn't present. My questions are as follows:

1) Would a serum immunofixation test be able to distinguish between a monoclonal protein disorder (multiple myeloma, waldenstrom macroglobulinemia, monoclonal gammopathy of undetermined significance) and globulin abnormalities stemming from hyperimmunization?

2) Would hyperimmunization show a monocolonal or polyclonal pattern on this test?

3) Finally, would having an overall normal globulin level of 2.3g/dl (reference range: 1.5 to 4.5) decrease suspicion of a monoclonal disorder at all? Total protein is 7.4 (range: 6.0-8.5), albumin is 5.1 (range: 3.5-5.5). A/G ratio is 2.2 (range: 1.1-2.5).

Thank you!

doctor
Answered by Dr. Shailja Puri (1 hour later)
Brief Answer:
Immunofixation will differentiate between plasma cell disorders

Detailed Answer:
Hello,
Thanks for posting your query on Health Care Magic.

Immunofixation is gold standard investigations which will differentiate between plasma cell disorders namelu - monoclonal gammopathy of unknown significance, multiple myeloma, Walderstorms macroglobulinemia etc.

The Rabies vaccination will induce production of specific antibodies which will not affect the results of immunofixation, since, these antibodies will be polyclonal and not monoclonal.

The total protein, albumin, globulin and A/G ratio are normal and show no abnormality.

Thanks and take care.
Dr Shailja Puri
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Shailja Puri (18 minutes later)
Thank you Dr. Puri for explaining that the vaccine will not cause a 'false positive' for monoclonal proteins.

I do realize that my total protein, albumin, globulin, and a/g ratio are all within normal limits, but my understanding is that one can have a monoclonal protein condition with these values being normal. What I'm trying to figure out is whether or not these being normal would greatly reduce the likelihood of a monoclonal disorder, although obviously falling short of actually ruling them out?

Thank you!
doctor
Answered by Dr. Shailja Puri (3 minutes later)
Brief Answer:
MGUS and smoldering myeloma can have normal protein values

Detailed Answer:
Hello and welcome again,
Monoclonal gammopathy of unknown significance (MGUS) and smoldering multiple myeloma can be accompanied by normal total protein, albumin, globulin and normal A/G ratio.

However, there is no harm in going for immunofixation since the investigation will clear your doubt.

Thanks and take care
Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
Dr.
Dr. Shailja Puri

Pathologist and Microbiologist

Practicing since :2006

Answered : 9705 Questions

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Can A Serum Immunofixation Test Differentiate Between Multiple Myeloma And Globulin Abnormalities?

Brief Answer: Immunofixation will differentiate between plasma cell disorders Detailed Answer: Hello, Thanks for posting your query on Health Care Magic. Immunofixation is gold standard investigations which will differentiate between plasma cell disorders namelu - monoclonal gammopathy of unknown significance, multiple myeloma, Walderstorms macroglobulinemia etc. The Rabies vaccination will induce production of specific antibodies which will not affect the results of immunofixation, since, these antibodies will be polyclonal and not monoclonal. The total protein, albumin, globulin and A/G ratio are normal and show no abnormality. Thanks and take care. Dr Shailja Puri