Immunoglobulin (IgG IgA IgM) Levels with Electrophoresis

Immunology

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Description

Immunoglobulins (IgG, IgA, IgM, IgD and IgE) are proteins with specific antigen binding activity (antibodies) and are synthesized by plasma cells and other B lymphocytes. The main indications for IgG, IgA and IgM quantification are in the diagnosis, exclusion or monitoring of patients with immunodeficiency or B cell malignancy. Characteristic immunoglobulin patterns have been described in association with many diseases, such as raised IgM in primary biliary cirrhosis, liver disease, renal disease & cryoglobulins and may be helpful when recognised by a skilled interpreter and in disease monitoring [3]. Immunochemical measurement of immunoglobulins cannot substitute for electrophoresis in the diagnosis of paraproteins and should be done together. Current guidelines for the investigation of Multiple Myeloma and Monoclonal Gammopathy of Uncertain Significance (MGUS) recommend that serum and urine electrophoresis should be used in the detection of B cell malignancy or plasma cell dyscrasia. This should be followed by immunofixation if there are any monoclonal bands present, or there are no bands present but there is high suspicion of B cell malignancy [1,5]. The guidelines also suggest that serum free light chains may be useful in monitoring free light chain only myeloma [1,2,5]. The concomitant use of serum free light chain measurements in specific circumstances is advocated [1,2], but it cannot currently replace current methods. Guidelines for the analysis of Bence Jones Protein suggest that urine electrophoresis is useful when myeloma is diagnosed, during follow-up and in the investigation of patient's who have suspected monoclonal gammopathy [6]. (See Bence Jones protein and Free Light Chains). Reductions in immunoglobulin levels can indicate primary immunodeficiencies (PID) or other severe secondary immunosuppression depending on the clinical history of the patient. Exclusion of other causes, results of other laboratory tests, and whether they fit the European Society for Immunodeficiencies (ESID) criteria for diagnosis should be considered during diagnosis [4].

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Indications

Diagnosis & Monitoring of Primary/Secondary immunodeficiency. Monitoring of IVIG replacement therapy. Lymphoproliferative disease. Plasma Cell Dyscrasias - Myeloma, Waldenstrom's Macroglobulinaemia. Connective tissue disease. Others (Discuss with Immunologist).

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Sample Type

2mL Serum (Gel 5mL Yellow tube). Requests from outside Sheffield: Transport at ambient temperature via Royal Mail or Courier.

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Reference Range

Age | IgG (g/L) | IgA (g/L) | IgM (g/L)
Cord | 5.2 - 18.0 | <0.02 | 0.02 - 0.2
0-2 weeks | 5.0 - 17.0 | 0.01 - 0.08 | 0.05 - 0.2
2-6 weeks | 3.9 - 13.0 | 0.02 - 0.15 | 0.08 - 0.4
6-12 weeks | 2.1 - 7.7 | 0.05 - 0.4 | 0.15 - 0.7
3-6 months | 2.4 - 8.8 | 0.10 - 0.5 | 0.2 - 1.0
6-9 months | 3.0 - 9.0 | 0.15 - 0.7 | 0.4 - 1.6
9-12 months | 3.0 - 10.9 | 0.2 - 0.7 | 0.6 - 2.1
1-2 years | 3.1 - 13.8 | 0.3 - 1.2 | 0.5 - 2.2
2-3 years | 3.7 - 15.8 | 0.3 - 1.3 | 0.5 - 2.2
3-6 years | 4.9 - 16.1 | 0.4 - 2.0 | 0.5 - 2.0
6-9 years | 5.4 - 16.1 | 0.5 - 2.4 | 0.5 - 1.8
9-12 years | 5.4 - 16.1 | 0.7 - 2.5 | 0.5 - 1.8
12-15 years | 5.4 - 16.1 | 0.8 - 2.8 | 0.5 - 1.9
15-45 years | 6.0 - 16.0 | 0.8 - 2.8 | 0.5 - 1.9
over 45 years | 6.0 - 16.0 | 0.8 - 4.0 | 0.5 - 2.0.

Reference ranges established by internal validation and PRU collaboration

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Turnaround Time

Within 3 days

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Testing Frequency

Daily

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External Notes

Send a Urine sample for urinary light chain analysis (Bence Jones Protein) if investigating for paraproteinaemias.

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References

Bird J et al. Guidelines for the investigation of newly detected M-proteins and the management of Monoclonal Gammopathy of Uncertain Significance (MGUS). British Council for Standards in Haematology. 2009. [Ref 1]Dispenzieri A, et al. International Myeloma Working Group guidelines for serum free-light chain analysis in multiple myeloma and related disorders. Leukaemia. 2009. 23:215-224. [Ref 2]PRU handbook of Clinical Immunochemistry. 9th Edition. 2007. [Ref 3]Geha RS, et al. Primary immunodeficiency diseases: An update from the International Union of Immunological Societies Primary Immunodeficiency Diseases Classification Committee. J Clin Allergy Imm. 2007. 120(4):776-794. [Ref 4]Smith A et al. Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haem. 2006. 132:410-451. [Ref 5]Siede WH and Regeniter A. Proteinuria - Diagnostics and interpretation with marker proteins. From the meeting; Proteins: from the laboratory to the Clinic. New Scientific Company. 2nd Edition. 2001. [Ref 6]Rajkumar S, et al. International myeloma working group updated criteria for the diagnosis of multiple myeloma. 2014. Lancet Oncology, 15:e538-548.Bird JM, et al. Guidelines for the diagnosis and management of multiple myeloma 2014. 2014. British Committee for Standards in Haematology (BCSH), UK myeloma Forum.NICE Guideline (NG35) Myeloma: diagnosis and management. February 2016 (updated October 2018).

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See Also

Bence Jones Protein/ Urine Light Chains; IgD; Total IgE; Serum free light chains.

Please note: the above information is subject to change and we endeavour to keep this website up to date wherever necessary.