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 increased or decreased in serum. It is frequently ordered to detect and identify monoclonal proteins – an excessive production of one specific immunoglobulin. Protein and immunofixation electrophoresis are ordered to help detect, diagnose, and monitor the course and treatment of conditions associated with these abnormal proteins, including multiple myeloma and a few other related diseases.

Protein is usually excreted in the urine in minute amounts. When it is present in moderate to large amounts, it often indicates some degree of kidney dysfunction and/or abnormal protein production. The primary reason that urine protein and immunofixation electrophoresis are ordered is to look for monoclonal protein production. This protein may show up in both the serum and urine, or it may be seen only in the urine.

Urine protein electrophoresis may also be ordered 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. Electrophoresis is not usually necessary to assess the loss of small to moderate amounts of protein due to temporary conditions, such as a urinary tract infection or an acute inflammation.

Protein electrophoresis may be ordered when a doctor is investigating symptoms that suggest multiple myeloma, such as bone pain, anemia, fatigue, unexplained fractures, and recurrent infections. It may also be ordered as a follow-up to other laboratory tests, such as an abnormal total protein and/or albumin level, elevated urine protein levels, elevated calcium levels, and low white or red blood cell counts. Immunofixation electrophoresis is usually ordered when the protein electrophoresis test shows the presence of an abnormal protein band that may be an immunoglobulin.

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.

Monoclonal protein production may be due to a monoclonal gammopathy of undetermined significance (MGUS). Most patients with MGUS have a benign course, but they must continue to be monitored regularly as some may develop multiple myeloma after a number of years.

Serum protein electrophoresis may also be ordered when symptoms suggest an inflammatory condition, an autoimmune disease, an acute or chronic infection, a kidney or liver disorder, or a protein-losing condition. Urine protein electrophoresis may be ordered when there is protein detected in the urine or when the doctor suspects a monoclonal protein may be present.

Protein and immunofixation electrophoresis tests give your doctor a rough estimate of how much of each protein is present. The value of protein electrophoresis lies in the proportions of proteins and in the patterns they create on the electrophoresis graph. The value of immunofixation electrophoresis is in the identification of the presence of a particular type of immunoglobulin.

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 (a1-antitrypsin deficiency, a rare genetic disease)

severe liver disease

Increased:

acute or chronic inflammatory diseases

Alpha2 globulin
Decreased:

hyperthyroidism

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: - chronic inflammatory disease
- rheumatoid arthritis
- systemic lupus erythematosus
- cirrhosis
- chronic liver disease
- acute and chronic infection
- recent immunization

Monoclonal: - Waldenstrom’s macroglobulinemia
- multiple myeloma
- monoclonal gammopathies of undetermined significance (MGUS)

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.