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  2. Protein electrophoresis serum Test

What is Protein Electrophoresis Serum test? 

The protein electrophoresis serum test measures the different types of proteins in your serum. Serum is the liquid component of the blood without clotting factors.

Proteins have a positive or negative charge and move when placed in an electric field. Using this principle, electrophoresis applies an electric current to separate serum proteins into groups of similar charge, size and shape.

The following proteins are detected in this test:

  • Albumin: Albumin comprises 60% of the total protein in the serum.
  • Globulin: Globulin includes all the proteins other than albumin in the serum. It is divided into alpha1, alpha2, beta1, beta2 and gamma globulins (antibodies).

These proteins move at different rates in an electric field and form a distinct pattern of bands that helps to identify certain diseases. Protein electrophoresis serum test is generally used to identify the presence of an abnormal protein called M protein in the serum. High amount of M proteins are seen in those with multiple myeloma (a type of cancer).

  1. Why is Protein Electrophoresis Serum test performed?
  2. How do you prepare for the Protein Electrophoresis Serum test?
  3. How is Protein Electrophoresis Serum test performed?
  4. Protein Electrophoresis Serum test results and normal levels

Why is Protein Electrophoresis Serum test performed?

Doctors usually perform this test to diagnose conditions affecting the plasma cells, such as multiple myeloma (plasma cell cancer), Waldenström’s macroglobulinaemia (a type of cancer of B lymphocytes), primary amyloidosis (a condition in which amyloid clumps are formed in body tissues) and monoclonal gammopathy of undetermined significance (MGUS) (a condition marked by the presence of abnormal proteins in the blood). Plasma cells are white blood cells which secrete antibodies essential for fighting infections in the body.

Plasma cell disorders may cause the following symptoms:

The test is also ordered for the diagnosis of other conditions associated with abnormal protein production or loss, such as:

How do you prepare for the Protein Electrophoresis Serum test?

You do not need any preparation before the test. Your healthcare practitioner will inform you if you need to stop food or water intake for a few hours before the test. Inform your doctor about any medicines you may be taking, which include prescribed, non-prescribed or illicit medicines, vitamins and supplements. Medicines such as corticosteroids, anabolic steroids, androgens, dextran, growth hormone, insulin, phenazopyridine and progesterone increase protein levels, whereas ammonium ions, hepatotoxic drugs, oestrogen and oral contraceptives decrease protein levels.

How is Protein Electrophoresis Serum test performed?

A blood sample is ordered for this test. Your healthcare practitioner will explain the steps of the test to you before it is conducted. He/she will draw a blood sample from a vein in your arm in the following manner:

  • The laboratory technician will tie a tourniquet (an elastic band) around your upper arm and ask you to tighten your fist. 
  • A sterile needle which is attached to a special container or syringe is inserted into a vein and the blood sample is drawn.
  • After drawing the sample, the band is released and the needle is removed.
  • The sample is labelled and sent to the laboratory for testing. 

You may experience mild pain or bruising at the needle insertion site after the test. However, these will usually fade away after some time.

Protein Electrophoresis Serum test results and normal levels

Normal results:

The reference ranges for serum proteins, expressed in grams per decilitre (g/dL), are listed in the table below:

Total protein 6.4-8.3 g/dL
Albumin 3.5-5.0 g/dL 
Alpha1 globulin 0.1-0.3 g/dL 
Alpha2 globulin 0.6-1.0 g/dL 
Beta globulin 0.7-1.2 g/dL 
Gamma globulin 0.7-1.6 g/dL

Abnormal results:

Increased levels of serum proteins are seen in the following conditions:

Protein Condition
Increased albumin Dehydration
Increased alpha1 globulin Pregnancy
Increased alpha2 globulin
  • Adrenal insufficiency
  • Adrenocorticosteroid therapy
  • Advanced diabetes mellitus
  • Nephrotic syndrome
Increased beta1 or beta2 globulin
  • Biliary cirrhosis
  • Carcinoma 
  • Cushing’s disease
  • Diabetes mellitus 
  • Hypothyroidism
  • Iron deficiency anaemia
  • Malignant hypertension
  • Nephrosis
  • Polyarteritis nodosa
  • Obstructive jaundice
  • Third-trimester pregnancy
Increased gamma globulin
  • Amyloidosis
  • Chronic infections (granulomatous diseases)
  • Waldenström’s macroglobulinaemia
  • Chronic lymphocytic leukaemia
  • Cirrhosis
  • Hodgkin’s disease
  • Malignant lymphoma
  • Multiple myeloma
  • Rheumatoid and collagen diseases (connective tissue disorders)

Decreased levels of serum proteins are seen in the following conditions: 

Protein Condition
Decreased total protein
  • Unusual loss of protein from the digestive tract or the inability of the digestive tract to absorb proteins (protein-losing enteropathy)
  • Malnutrition
  • Kidney disorder called nephrotic syndrome
  • Scarring of the liver and poor liver function (cirrhosis)
Decreased albumin
  • Chronic cachectic or wasting diseases
  • Chronic infections
  • Haemorrhage, burns or protein-losing enteropathies
  • Impaired liver function resulting from reduced synthesis of albumin
  • Malnutrition
  • Nephrotic syndrome
  • Pregnancy
Decreased alpha1 globulin Alpha1-antitrypsin deficiency
Decreased alpha2 globulin
  • Malnutrition
  • Megaloblastic anaemia
  • Protein-losing enteropathies
  • Severe liver disease
  • Wilson’s disease
Decreased beta1 or beta2 globulin     Protein malnutrition
Decreased gamma globulin

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Protein Electrophoresis (Blood)
  2. Austin Community College [Internet]. U.S.A. Serum or Plasma?
  3. Michigan Medicine: University of Michigan [internet]; Serum Protein Electrophoresis (SPEP)
  4. Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic and Laboratory Test Reference. 14th ed. Pg. 774-778
  5. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Multiple Myeloma
  6. Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 87, 88.
  7. Kapoor P et al. Diagnosis and Management of Waldenström Macroglobulinemia: Mayo Stratification of Macroglobulinemia and Risk-Adapted Therapy (mSMART) Guidelines 2016. JAMA Oncol. 2017 Sep 1;3(9):1257-1265. PMID: 28056114.
  8. Rajkumar SV. Plasma cell disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 187.
  9. Hawkins PN. Amyloidosis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 177.
  10. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Monoclonal Gammopathies
  11. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Protein electrophoresis - serum
  12. ARUP Labs [Internet]. University of Utah. Plasma Cell Dyscrasias
  13. National Health Service [internet]. UK; Blood Tests
  14. Chernecky CC, Berger BJ. Protein electrophoresis - serum. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:917-920.
  15. Warner EA, Herold AH. Interpreting laboratory tests. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 14.
  16. Theodore X. O' Connell, Timothy J. Horita, and Barsam Kasravi. Understanding and Interpreting Serum Protein Electrophoresis. Am Fam Physician. 2005 Jan 1;71(1):105-112.
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