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Received on February 20, 2006
Accepted on June 8, 2006
Hematology |
1 Department of Chemical Pathology, Derbyshire Royal Infirmary, Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
2 Department of Clinical Haematology, Derbyshire Royal Infirmary, Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
* To whom correspondence should be addressed. E-mail: julia.forsyth{at}derbyhospitals.nhs.uk.
Background: Retrospective analyses have established the role of quantitative serum free light chains (FLCs) in the diagnosis of monoclonal light chain disorders. The aims of this study were to assess (a) whether the addition of serum FLCs to serum protein electrophoresis (SPEP) identified additional patients with monoclonal gammopathies; (b) whether serum FLC measurements could replace urinalysis for Bence Jones protein (BJP); and (c) the cost/quality implications of routinely measuring serum FLCs.
Methods: Serum FLCs were added to consecutive requests for SPEP from August to November 2004 and measured by automated immunoassay.
Results: Seventy-one of 923 patients had abnormal serum FLC ratios. Seven patients with monoclonal gammopathies and 1 patient with malignant lymphoma (but no monoclonal band) were detected among 43 patients with negative SPEP but positive serum FLC ratios. Thirty-five patients with negative SPEP had false-positive serum FLC ratios. The false-positive rate for a ratio >1.65 was higher than previously described and associated with polyclonal increases in immunoglobulins and renal impairment. Serum FLC ratios were normal in 2 of 13 patients with low-level persistent urine BJP. However, no significant pathology would have been missed by replacing BJP with serum FLCs. Revenue and manpower savings offset 60% of the costs of serum FLCs.
Conclusions: Additional diagnostic information is gained by adding serum FLCs to SPEP as first-line tests for investigating possible B-cell disorders. The quality of the diagnostic service is enhanced by more confident exclusion of light chain disorders and improved interpretive assessment of SPEP and immunofixation electrophoresis.
The following articles in journals at HighWire Press have cited this article:
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  R. B Fulton and S. L Fernando Serum free light chain assay reduces the need for serum and urine immunofixation electrophoresis in the evaluation of monoclonal gammopathy Ann Clin Biochem, September 1, 2009; 46(5): 407 - 412. [Abstract] [Full Text] [PDF]
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 D. F. Keren Heavy/Light-Chain Analysis of Monoclonal Gammopathies Clin. Chem., September 1, 2009; 55(9): 1606 - 1608. [Full Text] [PDF]
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A. R. Bradwell, S. J. Harding, N. J. Fourrier, G. L.F. Wallis, M. T. Drayson, H. D. Carr-Smith, and G. P. Mead Assessment of Monoclonal Gammopathies by Nephelometric Measurement of Individual Immunoglobulin {kappa}/{lambda} Ratios Clin. Chem., September 1, 2009; 55(9): 1646 - 1655. [Abstract] [Full Text] [PDF]
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J. A. Katzmann, R. A. Kyle, J. Benson, D. R. Larson, M. R. Snyder, J. A. Lust, S. V. Rajkumar, and A. Dispenzieri Screening Panels for Detection of Monoclonal Gammopathies Clin. Chem., August 1, 2009; 55(8): 1517 - 1522. [Abstract] [Full Text] [PDF]
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 E. J.D. Robson, J. Taylor, C. Beardsmore, S. Basu, G. Mead, and T. Lovatt Utility of Serum Free Light Chain Analysis When Screening for Lymphoproliferative Disorders: The Experience at a District General Hospital in the United Kingdom Lab Med, June 1, 2009; 40(6): 325 - 329. [Full Text] [PDF]
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D. Siegel, E. Bilotti, and K. H. van Hoeven Serum Free Light Chain Analysis for Diagnosis, Monitoring, and Prognosis of Monoclonal Gammopathies Lab Med, June 1, 2009; 40(6): 363 - 366. [Abstract] [Full Text] [PDF]
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G. Palladini, P. Russo, T. Bosoni, L. Verga, G. Sarais, F. Lavatelli, M. Nuvolone, L. Obici, S. Casarini, S. Donadei, et al. Identification of Amyloidogenic Light Chains Requires the Combination of Serum-Free Light Chain Assay with Immunofixation of Serum and Urine Clin. Chem., March 1, 2009; 55(3): 499 - 504. [Abstract] [Full Text] [PDF]
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 J. M. Abadie, K.H. van Hoeven, and J. M. Wells Are Renal Reference Intervals Required When Screening for Plasma Cell Disorders With Serum Free Light Chains and Serum Protein Electrophoresis? Am J Clin Pathol, February 1, 2009; 131(2): 166 - 171. [Abstract] [Full Text] [PDF]
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J. A. Katzmann and A. Dispenzieri Screening Algorithms for Monoclonal Gammopathies Clin. Chem., November 1, 2008; 54(11): 1753 - 1755. [Full Text] [PDF]
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A. P. Piehler, N. Gulbrandsen, P. Kierulf, and P. Urdal Quantitation of Serum Free Light Chains in Combination with Protein Electrophoresis and Clinical Information for Diagnosing Multiple Myeloma in a General Hospital Population Clin. Chem., November 1, 2008; 54(11): 1823 - 1830. [Abstract] [Full Text] [PDF]
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G P Mead, H D Carr-Smith, and A R Bradwell Free light chains Ann Clin Biochem, July 1, 2008; 45(4): 444 - 444. [Full Text] [PDF]
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J. Sheldon Free light chains: author's response Ann Clin Biochem, July 1, 2008; 45(4): 445 - 446. [Full Text] [PDF]
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J. Forsyth and P. Hill Serum free light chains Ann Clin Biochem, July 1, 2008; 45(4): 444 - 445. [Full Text] [PDF]
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S. Daval, A. Tridon, N. Mazeron, J.-M. Ristori, and B. Evrard Risk of Antigen Excess in Serum Free Light Chain Measurements Clin. Chem., November 1, 2007; 53(11): 1985 - 1986. [Full Text] [PDF]
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E. S.K. Ma and E. T.K. Lee A Case of IgM Paraproteinemia in Which Serum Free Light Chain Values Were Within Reference Intervals Clin. Chem., February 1, 2007; 53(2): 362 - 363. [Full Text] [PDF]
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 J. A. Katzmann, A. Dispenzieri, R. A. Kyle, M. R. Snyder, M. F. Plevak, D. R. Larson, R. S. Abraham, J. A. Lust, L. J. Melton III, and S. V. Rajkumar Elimination of the Need for Urine Studies in the Screening Algorithm for Monoclonal Gammopathies by Using Serum Immunofixation and Free Light Chain Assays Mayo Clin. Proc., December 1, 2006; 81(12): 1575 - 1578. [Abstract] [Full Text] [PDF]
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J. A. Katzmann Serum Free Light Chain Specificity and Sensitivity: A Reality Check Clin. Chem., September 1, 2006; 52(9): 1638 - 1639. [Full Text] [PDF]
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