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首页> 外文期刊>Clinica chimica acta: International journal of clinical chemistry and applied molecular biology >Serum free light chain analysis may miss monoclonal light chains that urine immunofixation electrophoreses would detect.
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Serum free light chain analysis may miss monoclonal light chains that urine immunofixation electrophoreses would detect.

机译：无血清轻链分析可能会漏掉尿液免疫固定电泳会检测到的单克隆轻链。

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摘要

BACKGROUND: A nephelometric assay for identifying free light chains (FLC) of immunoglobulin in serum is commercially available. Although this assay is not specific for monoclonal FLC, an abnormal kappa/lambda ratio is thought to presumptively identify monoclonal FLCs. It has been proposed that serum FLC assays can replace urine immunofixation electrophoresis (IFE) for routine detection. This proposal seems to be based upon testing of samples retrospectively drawn from patients mostly with myeloma or known primary amyloidosis-conditions that are less frequently observed in general laboratory practice. METHODS: Prospective analysis of 5 patient samples by standard care techniques with serum/urine IFE compared with serum FLC nephelometric assay. Rather than classical myeloma, cases were selected on the basis of unusual or equivocal atypical serum protein electrophoresis patterns. RESULTS: In all 5 cases, the nephelometric method for free light chains was negative by virtue of serum FLC kappa/lambda ratio being within the reference range, contrasting with monoclonal proteins or free light chains detected by serum/urine IFE. CONCLUSIONS: Since peculiar or unusual patterns are more commonly observed in general practice, these cases illustrate the pitfalls of relying solely on the serum free light chain analysis method in order to establish the presence of monoclonal FLC.
机译：背景：用于确定血清中免疫球蛋白的游离轻链（FLC）的浊度测定法可商购获得。尽管此测定法并非特异性针对单克隆FLC，但据认为异常的Kappa /λ比可推测出单克隆FLC。已经提出，血清FLC测定法可以代替尿液免疫固定电泳（IFE）用于常规检测。该提议似乎是基于对从大多数患有骨髓瘤或已知原发性淀粉样变性病的患者中回顾性采集的样品进行测试的，这些患者在一般实验室实践中很少观察到。方法：采用血清/尿液IFE与血清FLC比浊法进行标准护理技术对5例患者样本进行前瞻性分析。不是根据典型的骨髓瘤，而是根据异常或模棱两可的非典型血清蛋白电泳模式选择病例。结果：在所有5例病例中，由于血清FLCκ/λ比值均在参考范围内，浊度法测定的游离轻链为阴性，与血清/尿液IFE检测到的单克隆蛋白或游离轻链相反。结论：由于在一般实践中通常观察到特殊或异常的模式，因此这些案例说明了仅依靠无血清轻链分析方法建立单克隆FLC的陷阱。

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