Protein electrophoresis is a laboratory technique that assesses the number and types of proteins in blood or urine. It is used to diagnose and monitor conditions that are associated with abnormal protein production. It is most often used in multiple myeloma, a cancer of certain types of white blood cells. Less commonly, it is used to investigate other cancers such as lymphoma, chronic lymphocytic leukemia, and Waldenstrom macroglobulinemia as well as kidney disease and inflammatory diseases such as autoimmune disorders, and liver disease.

Our bodies are made up of thousands of different proteins. They are the building blocks of all cells and tissues, and they also make up enzymes and some hormones that regulate bodily functions. They are continually being replaced with new proteins.

Your doctor may request a protein electrophoresis test:

• if they suspect you may have a condition that is associated with abnormal protein production or, 
• you have had an abnormal result on a laboratory test for proteins such as total protein, albumin, or an immunoglobulins blood test.

Protein electrophoresis separates proteins based on their size and electrical charge. After the initial electrophoresis step an additional process called immunofixation electrophoresis (IFE) enables further identification of specific proteins. 

Knowing which proteins are present, absent, elevated, or decreased in body fluids such as blood and urine can help diagnose and/or monitor many diseases and conditions. 

The two major types of proteins are:

• Albumin, which is produced in the liver and accounts for about 60 per cent of protein in the blood.
• Globulins, which are proteins other than albumin. Except for antibodies and some complement proteins, most globulins are also produced in the liver.

When it is requested

Electrophoresis testing is most often requested when a doctor suspects a disease or condition that causes a monoclonal protein to be produced.  

It is used for both diagnosis and to monitor the course of a condition and the effectiveness of treatment. If a disease progresses the amount of protein goes up but with treatment it goes down.

Electrophoresis can be used to help diagnose or monitor many conditions including:

• Multiple myeloma 
• Other forms of cancer, such as lymphoma, chronic lymphocytic leukemia, Waldenstrom macroglobulinemia
• Monoclonal gammopathy of undetermined significance (MGUS)
• Kidney disease
• Inflammatory disorders including autoimmune diseases such as lupus, and liver disease
• Malnutrition or malabsorption conditions

If you have an abnormal monoclonal immunoglobulin in your blood, it does not necessarily mean you have multiple myeloma or some other type of cancer.  

Monoclonal protein production may be due to a condition known as monoclonal gammopathy of undetermined significance (MGUS). Most people with MGUS initially have a benign course but may progress to a more serious condition. They must continue to be monitored regularly with a serum protein electrophoresis test, or sometimes a free light chain test, depending on which monoclonal protein is being produced. 

Urine protein electrophoresis

In some situations, a urine test may be requested. Protein is usually found in the urine only in very small amounts. Moderate to large amounts of protein in urine are associated with kidney disease and multiple myeloma. The main reason the test is requested on urine is to look for monoclonal protein which may show up in both the serum and urine, or it may only be seen in the urine.

Multiple myeloma:  Normally, antibodies are composed of four parts – two identical heavy chains and two identical light chains.  Bence Jones protein is the light chain component of antibodies. Sometimes in multiple myeloma, only one or the other is produced or too much is produced. The small size of Bence Jones protein allows it to pass through the kidneys and enter the urine.

Kidney disease: Urine protein electrophoresis may also be used to help diagnose the cause and estimate the severity of protein excretion due to kidney damage or disease. This damage or disease may be due to diabetes, chronic inflammation, an autoimmune condition or a malignancy. 

Sample

Blood or sometimes a random urine sample or 24-hour urine sample

Any preparation?

None 

The information from protein and immunofixation electrophoresis can provide clues that a disease or condition is affecting protein production or loss of protein, but the results usually do not provide a definitive diagnosis. Instead, additional follow-up tests are needed to investigate the cause and to try to identify the nature of the underlying disease.
 

Results can suggest the following:The choice of tests your doctor makes will be based on your medical history and symptoms.   It is important that you tell themeverything you think might help. 

You play a central role in making sure your test results are accurate. Do everything you can to make sure the information you provide is correct and follow instructions closely. 

Talk to your doctor about any medications you are taking. Find out if you need to fast or stop any particular foods or supplements. These may affect your results. Ask:

• Why does this test need to be done?
• Do I need to prepare (such as fast or avoid medications) for the sample collection?
• Will an abnormal result mean I need further tests?
• How could it change the course of my care?
• What will happen next, after the test?

Your doctor can sometimes request an electrophoresis test because you could have an abnormality even though the total protein and albumin are normal. This is because the body tries to maintain a constant amount of protein and may increase or decrease its production of other proteins to compensate for a deficiency or overproduction of others. 

Pathology and diagnostic imaging reports can be added to your My Health Record. You and your healthcare provider can now access your results whenever and wherever needed.
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