Summary

• Protein electrophoresis is a laboratory technique that analyses the various types of proteins in blood or urine.
• It is mostly used to diagnose and monitor multiple myeloma, a cancer of certain types of white blood cells.
• Less often, it is used to look at other cancers such as lymphoma, and chronic lymphocytic leukemia.
• It is also used to investigate non-cancerous conditions such as kidney disease and inflammatory diseases including autoimmune disorders, and liver disease.

What is protein electrophoresis?

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 doctors may request a protein electrophoresis test:

• if they suspect you may have a condition in which your body is not making some proteins correctly 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, another process called immunofixation electrophoresis (IFE) helps to find specific proteins.

Knowing which proteins are present, absent, high or low 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.

The M-protein

Electrophoresis testing is most often requested when it is suspected you have a disease or condition that causes a monoclonal protein to be made.

Your immune system protects you by making antibodies to attack substances that should not be in your body and could be harmful to you. Normally, your body makes lots of different antibodies. They’re all slightly different to fight a wide range of infections and potential toxic substances. They are made by plasma cells, a type of white blood cell, in your bone marrow.

However, in some forms of cancer, like multiple myeloma, plasma cells acquire mutations in their DNA. One plasma cell becomes abnormal, and it does not work properly, and it keeps making the same antibody over and over. This results in a large amount of just one type of antibody in the blood. This is called the monoclonal protein, or the M-protein. These proteins can:

• Build up in the blood, making it thick
• Deposit in organs (like kidneys), causing damage.

The abnormal plasma cells multiply in the bone marrow, crowding out normal blood-forming cells. This leads to:

• Anaemia (not enough red cells)
• Low white cells (infections)
• Low platelets (bleeding problems)

Finding an M-protein in the blood often suggests a plasma cell disorder, such as:

• Multiple myeloma
• Other forms of cancer, such as lymphoma, chronic lymphocytic leukemia, Waldenstrom macroglobulinemia.

If you have an M-protein in your blood, it does not necessarily mean you have multiple myeloma or some other type of cancer. Monoclonal proteins may be due to a condition known as monoclonal gammopathy of undetermined significance (MGUS). This is not cancer, but it’s considered a precursor condition that can sometimes progress to multiple myeloma or other related blood cancers. People with this must be monitored regularly with a serum protein electrophoresis test, or sometimes a free light chain test, depending on which M-protein is being made.

Kidney disease

In some situations, a urine protein electrophoresis 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. This damage or disease may be due to diabetes, chronic inflammation, an autoimmune condition or a malignancy.

The main reason the test is requested on urine is to look for M-protein which may show up in both the blood and urine, or it may only be seen in the urine.

Liver disease and inflammatory disorders

Inflammation (acute or chronic) causes the liver and immune system to change protein production.

Protein electrophoresis is used for both diagnosis and to monitor the course of a condition and check how well treatment is working.

Having the test

Sample

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

Any preparation?

None.

Your results

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.

Any more to know?

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.

Questions to ask your doctor

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?

More information

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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