serum protein electrophoresis project
TRANSCRIPT
Serum protein electrophoresis project
Serum protein electrophoresis
• Primary role is to detect monoclonal immunoglobulins associated with plasma cell dyscrasias and lymphoproliferative disorders
SPEP report - What do clinicians want?
• Is there a paraprotein?
• What is the isotype and concentration?
• Cumulative reporting – to calculate the response to the therapy/ to monitor the progression of disease or relapse
• Recognition and reporting of oligoclonal and small bands that occur post BM transplant or novel therapy
• Uniform approach to report paraproteins which migrate with normal serum proteins
• Consistent reporting of paraproteins
Why do we need harmonised approach in testing & reporting?
• Remove unwanted variation in inter-laboratory results
• Electronic medical records
• Facilitate better patient management
Clinical guidelines related to plasma cell dyscrasias • Clinical guidelines make little mention of laboratory issues/ variations
• Strict cut-offs for diagnosis and monitoring – absolute value or % change
eg:
Are there any laboratory guidelines/ recommendations in Aus & NZ?
• Recommendations for - Nomenclature
- Detection systems
- Serum protein and albumin quantification
- Quantitative reporting of SPEP fractions
- Quantification small bands and paraproteins co-migrating with other normal proteins in alpha and beta regions
- Serum and urine paraprotein quantification
- Paraprotein characterization
- Laboratory performance of SPEP, UPEP and IFE
- Laboratory expertise and staffing
- Report formats
Do we report comparable SPEP results between labs?
• Yes
• No
• May be
• Don’t know
Mr A – Known patient with IgA kappa MM. On Rx.
What do you think about this patient’s disease progress?
Lab X 1/01/2018
Total Protein 71 g/L
Albumin 37 g/L
Paraprotein Detected
Type IgA kappa
Concentration 4 g/L
Lab Y 1/02/2018
Total Protein 72 g/L
Albumin 38 g/L
Alpha-1 2.6 g/L
Alpha-2 7 g/L
Beta-1 4.4 g/L
Beta-2 6.1 g/L
Paraprotein Detected
Type IgA kappa
Concentration 12 g/L
Total IgA 5 g/L
Comment
This paraprotein was
detected in the beta
region. The reported
concentration
includes both the
paraprotein and
normal beta proteins
(~7 g/L).
What are the areas with significant inter-laboratory variation?
• Quantification of co-migrating paraproteins in the beta/ alpha region
• Quantification / reporting of small bands
• Report formats / comments?
• Nomenclature and units
• Others???
What are the reasons for inter-lab variation?
• Different analytical methods – eg:Capillary Vs Gel, ISUB Vs IFE
• Different techniques of paraprotein quantification – Perpendicular/ tangent skimming/ corrected perpendicular
• Different report formats - ? due to LIS limitations/ clinician preferences/ ?? historical – don’t want to change
• Others??
2017 AACB/ RCPA QAP Protein workshop in Melbourne
• Overview of current clinical guidelines/ updates on plasma cell dyscrasias
• SPEP and SFLC measurements – current lab practice
• New challenges – eg: therapeutic monoclonal Ab interference
• Need for the update of 2012 Australian and NZ recommendations
- Approach to co-migrating paraproteins
- Reporting of small bands
- ? Others
- Survey questionnaire through RCPAQAP
- Paraprotein sample swap
2018 –SPEP sample swap – Victoria
2018 –SPEP sample swap – Victoria
2018 –SPEP sample swap – QLD
2018 –SPEP sample swap – WA
2018 –SPEP sample swap – NSW
Should we harmonise the laboratory testing of plasma cell dyscrasias?