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Immunoglobulin Electrophoresis, Immunoglobulins Pattern in Various Diseases

December 20, 2022Immune systemLab Tests

Table of Contents

  • Immunoglobulin Electrophoresis
      • Sample for Immunoglobulin Electrophoresis
      • Purpose of Immunoglobulin Electrophoresis (Indications) 
      • Definition of immunoglobulin electrophoresis:
      • Serum proteins consist of:
    • Examples of some immunoglobulin electrophoresis patterns:
    • Myeloma pattern:
    • Hypogammaglobulinemiaa pattern:
    • Cirrhosis pattern:
    • Polyclonal gammopathy pattern:
    • Acute reaction pattern:
    • Chronic inflammatory pattern:
    • Nephrotic syndrome pattern:
      • Increased IgG level is seen in:
      • Decreased IgG level is seen in:
      • Increased IgM level is seen in:
      • Decreased IgM level is seen in:
      • Increased level of IgA seen in:
      • Decreased level of IgA seen in:
      • Increased IgE level is seen in:
      • Decreased IgE level was seen in:
      • Increased monoclonal gammopathy is seen in:
      • Increased polyclonal gammopathy is seen in:
      • Increased monoclonal gammopathy is  seen in Urine:

Immunoglobulin Electrophoresis

Sample for Immunoglobulin Electrophoresis

  1. Venous blood is needed to prepare the serum.
  2. A random sample can be taken.

Purpose of Immunoglobulin Electrophoresis (Indications) 

  1. It is advised to diagnose many diseases like Multiple Myeloma etc.
  2. Waldenstrom macroglobulinemia.
  3. Immunoglobulin electrophoresis is advised if there is a spike in the gamma band in serum electrophoresis.
  4. Hypersensitivity reactions.
  5. Immune deficiency.
  6. Autoimmune diseases.
  7. Chronic infections.
  8. Intrauterine fetal infection.
  9. Hypogammaglobulinemia.
  10. Agammaglobulinemia.
  11. Analbumionemia.
  12. Bisalbuminemia.
  13. Afibrogenemia.
  14. Atransfferenemia.
  15. Cirrhosis.
  16. Acute-phase proteins.

Definition of immunoglobulin electrophoresis:

  1. It is the immunochemical method to separate the various proteins and immunoglobulins.
  2. This technique can be used in the serum or cerebrospinal fluid (CSF).
  3. It is used to evaluate gammopathies.
  4. It is said that no pattern is pathognomonic of any single disease.

Serum proteins consist of:

  1. Albumin
  2. Globulins.
  3. Globulins are of two types:
    1. One formed in the liver.
    2. The second produces by the immune cells.
  4. One of the globulin is called gamma globulin.
  5. The antibodies are made of gamma globulin called immunoglobulin (Ig).
  6. There are five main types of immunoglobulins (Ig) labeled:
    1. IgG, which is 75% of the total Ig.
      1. γ-region is predominantly composed of IgG.
    2. IgM is 10%  to 12%
    3. IgA consists of 15% of the total Ig.
    4. IgE
    5. IgD
      1. IgA, IgM, IgD, and IgE share the junction of β and γ-globulin.
Immunoglobulin Electrophoresis: Electrophoresis serum

Immunoglobulin Electrophoresis: Electrophoresis serum

Examples of some immunoglobulin electrophoresis patterns:

Myeloma pattern:

  1. In myeloma and Waldenstrom’s Macroglobulinemia showed prominent γ- fraction, monoclonal gammopathy band.
  2. A monoclonal gammopathy band has also been seen in idiopathic or secondary gammopathy.
Electrophoresis polyclonal gammopathy

Immunoglobulin Electrophoresis: Electrophoresis polyclonal gammopathy

Hypogammaglobulinemiaa pattern:

  1. There are decreased γ-globulins.
  2. There are no changes in other globulins.
  3. It may represent a light chain variant of multiple myeloma (nearly 20% of multiple myeloma).
  4. In light chain myeloma, urine is positive for Bence Jones proteinuria.
Electrophoresis hypogammaglobulinemia pattern

Electrophoresis hypogammaglobulinemia pattern

Cirrhosis pattern:

  1. Electrophoresis in cirrhosis typically shows low albumin.
  2. There is a moderate or considerably raised band of gamma-globulin.
  3. β-peak is mixed with the γ-globulin.
Electrophoresis cirrhosis

Electrophoresis cirrhosis

Polyclonal gammopathy pattern:

  1. There is a significantly increased gamma-globulin level involving the entire band.
  2. There is no thin spike-like appearance.
  3. There may be some β-globulin bridging with the γ-band.
  4. It is seen in:
    1. Some cases of cirrhosis.
    2. Chronic infection.
    3. Granulomatous diseases like sarcoidosis or pulmonary tuberculosis.
    4. Subacute endocarditis.
    5. Some cases of rheumatoid arthritis, polyarteritis nodosa, and systemic lupus erythematosus.
Electrophoresis polyclonal gammopathy

Electrophoresis polyclonal gammopathy

Acute reaction pattern:

  1. It consists of decreased albumin.
  2. There are raised α-2 globulin levels.
  3. This pattern is seen in early acute infection and some cases of acute myocardial infarction.
  4. This may be seen in severe burns, surgery, and other stress conditions.
Electrophoresis acute pattern

Electrophoresis acute pattern

Chronic inflammatory pattern:

  1. There is decreased albumin.
  2. There is a moderately increased γ-globulins.
  3. α-2-globulin is normal or slightly raised.
  4. This pattern is found in:
    1. Chronic infections.
    2. Granulomatous diseases.
    3. Rheumatoid collagen diseases.
    4. It may be found in cirrhosis.
Electrophoresis chronic pattern

Electrophoresis chronic pattern

Nephrotic syndrome pattern:

  1. There is a markedly decreased level of albumin.
  2. There is a moderate increase in α-2 globulin level.
    1. This α-2 globulin level of nephrotic syndrome is slightly or moderately greater than in acute infection.
Electrophoresis nephrotic syndrome

Electrophoresis nephrotic syndrome

The Normal level of Immunoglobulins

 Immunoglobulins normal level at various ages:

Age IgG IgM IgA IgD IgE
Adult 565 to 1765 mg/dL 55 to 375 mg/dL 85 to 385 mg/dL minimum minimum
2 to 5 months 200 to 700 mg/dL 25 to 100 mg/dL 4 to 80 mg/dL
One year 430 to 1200 mg/dL 35 to 125 mg/dL 15 to 110 mg/dL
4 to 12 years 460 to 1600 mg/dL 50 to 250 mg/dL 25 to 350 mg/dL

Increased IgG level is seen in:

  1. Multiple myelomas (Monoclonal IgG gammopathy).
  2. Hyperimmunization reaction.
  3. Chronic granulomatous infection.
  4. Chronic liver diseases.
  5. Autoimmune diseases like rheumatoid arthritis, Sjogren’s syndrome, and SLE.

Decreased IgG level is seen in:

  1. Agammaglobulinemia.
  2. Wiskott-Aldrich syndrome.
  3. AIDS (acquired immune deficiency syndrome).
  4. Nephrotic syndrome.
  5. Protein-losing enteropathy.

Increased IgM level is seen in:

  1. Waldenstrom macroglobulinemia.
  2. Chronic infections.
  3. Autoimmune diseases like rheumatoid arthritis and SLE.
  4. Acute infection is a primary immune response.
  5. Chronic liver diseases like biliary cirrhosis.

Decreased IgM level is seen in:

  1. Agammaglobulinemia.
  2. Hypoproteinemia is seen in nephrotic syndrome and protein-losing enteropathy.
  3. AIDS
  4. Immunosuppression is due to drugs like steroids and dextran.

Increased level of IgA seen in:

  1. Primary biliary cirrhosis.
  2. Inflammatory bowel disease.
  3. Chronic infectious.

Decreased level of IgA seen in:

  1. Hypoproteinemia due to nephrotic syndrome and protein-losing enteropathy.
  2. Ataxia.
  3. Immunosuppression is due to drugs like steroids.
  4. Congenital isolated deficiency of IgA.
  5. Telangiectasia.

Increased IgE level is seen in:

  1. Allergic reactions like hay fever, asthma, eczema, and parasites.
  2. In an anaphylactic reaction.

Decreased IgE level was seen in:

  1. Agammaglobulinemia.

Increased monoclonal gammopathy is seen in:

  1. Multiple myelomas.
  2. Waldenstrom macroglobulinemia.

Increased polyclonal gammopathy is seen in:

  1. Amyloidosis.
  2. Chronic liver disease.
  3. Chronic infections.
  4. Autoimmune diseases.

Increased monoclonal gammopathy is  seen in Urine:

  1. Waldenstrom macroglobulinemia.
  2. Multiple myelomas.

Questions and answers:

Question 1: What is the appearance of albumin in nephrotic syndrome?
Show answer
Albumin in the serum of nephrotic syndrome is very low.
Question 2: What is the picture in acute stress?
Show answer
There is decreased level of albumin and increased alpha-2 globulin.

 

Possible References Used
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