The patient in question is being worked up for suspected multiple myeloma. Patients with multiple myeloma
secrete abnormal levels of certain proteins called M protein. The investigation of M protein involve the
following steps. First, the M protein is detected using protein electrophoresis. Second, the nature of the M
protein is identified using Immunoelectrophoresis or Immunofixation. Lastly, the amount of M protein may be
quantified using a test known as Single Radial Immunodiffusion or other techniques.
To give a brief background, Protein Electrophoresis is used to seperate out the different protein classes
present in blood serum using a small electric current. The seperated protein classes form different bands, and
these are labelled as Albumin, Alpha 1, Alpha 2, Beta, and Gamma. The doctors are specifically interested in
the Gamma band, and check if this Gamma band on electrophoresis is broad or narrow. Normal patients have a
diffuse, broad Gamma band. In patients with multiple myeloma, PEP reveals a single, sharp protein band in the
The initial protein electrophoresis (PEP) of the patient revealed a monoclonal protein band. This strengthened
the clinical suspicion of Multiple Myeloma, and the next test, or serum Immunofixation test was ordered.
A brief background of the Immunofixation test: We know that patients of multiple myeloma secrete
immunoglobulins. These contain sub-parts called heavy-chains and light-chains. The heavy chains are usually of
a type called IgG, may sometimes be IgA, and rarely be IgM, IgD, or IgE. The light chains in multiple myeloma
patients are either Kappa or Lambda but not both. Normal patients have both Kappa and Lambda. The
Immunofixation test thus identifies the type of light chain that a particular patient has; in this case the
test was Kappa positive.
The patient in question should now undergo other routine blood investigations, liver function tests, renal
function tests, bone marrow aspirate and biopsy examination, radiological skeletal survey, and serum beta
microglobulin test. Treatment should begin after confirming diagnosis and appropriate staging procedures.