Also known as: Serum Protein Electrophoresis; Protein ELP; SPE; SPEP; Urine Protein

Electrophoresis; UPE; UPEP; IFE; CSF Protein Electrophoresis

Formal name: Protein Electrophoresis; Immunofixation Electrophoresis
Related tests: Albumin; Total Protein; Antibody Tests; Immunoelectrophoresis; Urine Protein;
Serum Free Light Chains; Quantitative Immunoglobuins; Alpha-1 Antitrypsin; Cryoglobulin

Why Get Tested?

To help diagnose or monitor conditions that result in abnormal protein production or
loss

When to Get Tested?

If you have an abnormal total protein or albumin blood test or if you have symptoms
of diseases that are characterized by abnormal protein production, such as multiple
myeloma or multiple sclerosis

Sample Required?
A blood sample drawn from a vein in your arm; sometimes a random or 24-hour urine
sample; sometimes a sample of cerebrospinal fluid

Test Preparation Needed?

None

The Test Sample

What is being tested?
Body fluids contain many different proteins that serve diverse functions such as
transport of nutrients, removal of toxins, control of metabolic processes, and defense
against invaders. Protein electrophoresis is a method for separating these proteins
based on their size and electrical charge. When body fluids are separated by
electrophoresis, they form a characteristic pattern of bands of different widths and
intensities, reflecting the mixture of proteins present. This pattern is divided into five
fractions, called albumin, alpha 1, alpha 2, beta, and gamma. In some cases, the beta
fraction is further divided into beta 1 and beta 2.
Albumin, which is produced in the liver, accounts for about 60% of the protein in the
blood. "Globulins" is a collective term used to refer to proteins other than albumin.
With the exception of the immunoglobulins and some complement proteins, most of
the globulins are also produced in the liver.

Immunofixation electrophoresis (IFE) is a method used to identify abnormal bands

seen on serum, urine, or CSF protein electrophoresis, as to which type of antibody
(immunoglobulin) is present.
The major plasma proteins and their functions are listed according to their
electrophoretic group in a table titled Protein Groups.

How is the sample collected for testing?

Protein electrophoresis is typically done on serum and urine samples. A blood sample
is obtained by inserting a needle into a vein in the arm. Urine samples may either be a
random sample (not timed) or a 24-hour urine sample. CSF is collected by a spinal tap
(inserting a needle into the spine to withdraw spinal fluid).

Is any test preparation needed to ensure the quality of

the sample?
No test preparation is needed.

How is it used?
Electrophoresis is used to identify the presence of abnormal proteins,
to identify the absence of normal proteins, and to determine when
different groups of proteins are present in unusually high or low
amounts.
Alterations to the usual appearance of these patterns can help in the
diagnosis of disease. The presence of an abnormality on a protein
electrophorectic pattern is seldom diagnostic in itself. Instead, it provides a
clue. Follow-up testing is then undertaken, based on that clue, to try to identify
the nature of the underlying disease.

When is it ordered?
Protein electrophoresis may be ordered to help in diagnosis of a disease or it
may be ordered to monitor treatment. When used to help in diagnosis, it may
be ordered as a follow up to abnormal findings on other laboratory tests or as
an initial test in evaluating a person's symptoms. Once a disease or condition
has been diagnosed, electrophoresis may be ordered at regular intervals to
monitor the course of the disease and the effectiveness of treatment. Some
examples of when an electrophoresis test may be ordered are listed below.
Serum electrophoresis may be ordered:

As a follow up to abnormal findings on other laboratory tests, such as total protein

and/or albumin level, elevated urine protein levels, elevated calcium levels, or low
white or red blood cell counts
When symptoms suggest an inflammatory condition, an autoimmune disease, an
acute or chronic infection, a kidney or liver disorder, or a protein-losing condition
When a doctor is investigating symptoms that suggest multiple myeloma, such as
bone pain, anemia, fatigue, unexplained fractures, or recurrent infections, to look
for the presence of a characteristic band (monoclonal immunoglobulin) in the
beta or gamma region; if a sharp band is seen, its identity as a monoclonal
immunoglobulin is typically confirmed by immunofixation electrophoresis.
To monitor treatment of multiple myeloma to see if the monoclonal band is
reduced in quantity or disappears completely with treatment

Urine protein electrophoresis may be ordered:

When protein is present in urine in higher than normal amounts to determine the
source of the abnormally high protein; it may be used to determine whether the
protein is escaping from the blood plasma (suggesting compromised kidney
function) or is an abnormal protein coming from a different source (such as a
plasma cell cancer like multiple myeloma).
When multiple myeloma is suspected, to determine whether any of the
monoclonal immunoglobulins or fragments of monoclonal immunoglobulin are
escaping in to the urine; if a sharp band suggestive of a monoclonal protein is
observed, its identity is typically confirmed by immunofixation electrophoresis.

CSF protein electrophoresis may be ordered:

To search for the characteristic banding seen in multiple sclerosis; the presence
of multiple distinct bands in the CSF (that are not also present in serum) are
referred to as oligoclonal bands. Most people with multiple sclerosis, as well as
some other inflammatory conditions of the brain, have such oligoclonal bands.
To evaluate people having headaches or other neurologic symptoms to look for
proteins suggestive of inflammation or infection.

Immunofixation electrophoresis may be ordered:

When an abnormal band suggestive of a monoclonal immunoglobulin is seen on

either a serum or a urine electrophoresis pattern

What does the test result mean?

Protein electrophoresis tests give your doctor a rough estimate of how much
of each protein fraction is present and whether any abnormal proteins are

present. The value of immunofixation electrophoresis is in the identification of

the presence of a particular type of immunoglobulin.
Serum electrophoresis
Certain conditions or diseases may be associated with decreases or
increases in various serum proteins, as reflected below.
Albumin
Decreased:

Malnutrition and malabsorption

Pregnancy
Kidney disease (especially nephrotic syndrome)
Liver disease
Inflammatory conditions
Protein-losing syndromes

Increased:

Dehydration

Alpha1 globulin
Decreased:

Congenital emphysema (alpha-1 antitrypsin deficiency, a rare genetic disease)

Severe liver disease

Increased:

Acute or chronic inflammatory diseases

Alpha2 globulin
Decreased:

Malnutrition
Severe liver disease
Hemolysis

Increased:

Kidney disease (nephrotic syndrome)

Acute or chronic inflammatory disease

Beta globulin
Decreased:

Malnutrition
Cirrhosis

Increased:

Hypercholesterolemia
Iron deficiency anemia
Some cases of multiple myeloma or MGUS

Gamma globulin
Decreased:

Variety of genetic immune disorders

Secondary immune deficiency

Increased:

Polyclonal:
o
o
o
o
o
o
o

Chronic inflammatory disease

Rheumatoid arthritis
Systemic lupus erythematosus
Cirrhosis
Chronic liver disease
Acute and chronic infection
Recent immunization

Monoclonal:
o
o
o
o

Malignancy
Multiple myeloma
Lymphoma
Waldenstrom's macroglobulinemia

Urine electrophoresis
Usually there is very little protein in urine. Typically, if a significant amount of
protein is present, it appears in one of three main patterns.

Normally, the glomeruli, the first part of the kidney, prevent protein from leaking
into the urine. When the glomeruli are damaged, albumin and other plasma
proteins may leak through and be detected in the urine.
Normally, some very small proteins can pass through the glomeruli but are
removed from the urine by the tubules. When the tubules are damaged, these
proteins will appear in the urine.
Some other small proteins are not normally present in significant amounts in
serum, for example, free light chains, myoglobin and hemoglobin. When they are
present in the serum, they can pass through the glomeruli and appear in the urine
.

CSF electrophoresis

Presence of multiple bands in the gamma region (oligoclonal bands) that are not
present in serum is indicative of multiple sclerosis.
Presence of higher than normal polyclonal immunoglobulins suggests an
infection.

Immunofixation electrophoresis

Identifies the type of immunoglobulin protein(s) present in monoclonal bands on a

protein electrophoresis pattern; typically immunofixation determines the presence
of a heavy chain (IgG, IgM or IgA) and a light chain (kappa or lambda). For more
about this, see Common Questions #3.

Is there anything else I should know?

Immunizations within the previous six months can increase immunoglobulins
as can drugs such as phenytoin (Dilantin), procainamide, oral contraceptives,
methadone, and therapeutic gamma globulin.
Aspirin, bicarbonates, chlorpromazine (Thorazine), corticosteroids, and
neomycin can affect protein electrophoresis results.

Common questions
1. Is electrophoresis used for anything else?
Yes, any time a separation of molecules is desired. DNA electrophoresis, for
instance, is used to help study the genetic makeup of plants, animals, and
humans.

2. If I have an abnormal monoclonal immunoglobulin in my

blood, does it mean that I have multiple myeloma or some
other type of cancer?
Not necessarily. Monoclonal protein production is most commonly due to
monoclonal gammopathy of undetermined significance (MGUS). Most people
with MGUS have a benign course, but 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. Some of
these people may develop multiple myeloma after a number of years.

3. What are free light chains and how are they related to
immunoglobulins?
Immunoglobulins are molecules composed of four protein chains: two
identical light chains, either kappa or lambda light chains, and two identical
heavy chains of which there are several types. These proteins are produced
by plasma cells in the bone marrow. A particular plasma cell only produces
one type of immunoglobulin. It uses the protein chains as component parts to
assemble immunoglobulins antibodies that target specific threats to the
body. The chains that are used to form the immunoglobulins are said to be
"immunoglobulin-bound." Normally, there is also a slight excess of kappa and
lambda light chains produced. Low levels of these "free" light chains can be
detected in the blood and urine with a free light chain test, and ratios between
the kappa and lambda free light chains can be evaluated.

4. What are Bence Jones proteins?

They are free immunoglobulin light chains that are found in the urine.

5. What is Tamm-Horsfell protein?

The term Tamm Horsfell refers to a glycoprotein that is a normal component of
urine. It is more commonly called uromodulin. It is produced by the kidney and
is the most abundent protein in normal urine.
Resources:
http://labtestsonline.org/understanding/analytes/electrophoresis/tab/faq