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Occurrence of Monoclonal Band in Alpha Region on Serum Electrophoresis in Multiple Myeloma: A Diagnostic Conundrum

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Abstract

The presence of an M-band in serum and/or urine electrophoresis is a crucial diagnostic indicator for multiple myeloma and other plasma cell dyscrasias. Conventionally, on serum protein electrophoresis (SPEP), the M-band is observed as a sharp spike (M-spike), typically in the gamma region, occasionally in the beta region, and rarely in the alpha region. However, the infrequency of M-bands in the alpha region raises the possibility of overlooking them when coexisting with normal bands. This study underscores the significance of considering the potential discovery of M-bands in unusual sites, particularly in the alpha-2 region. This retrospective study spanned three years and involved conducting serum and urine protein electrophoresis followed by serum and urine immunofixation electrophoresis on a semi-automated platform (Helena Biosciences, Europe) using agarose gel and serum protein 6-band format kits. We identified five cases of multiple myeloma presenting with a monoclonal band in the alpha-2 region on SPEP and UPEP. Subsequent immunofixation electrophoresis confirmed these bands to be monoclonal bands in the lambda lane. In suspected cases of multiple myeloma, even in the absence of an M-band in the gamma region, heightened prominence in the alpha or beta region warrants further investigation through immunofixation electrophoresis (IFE).

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Authors and Affiliations

  1. Post Graduate Institute of Medical Research and Education, Chandigarh, PIN-160012, India

    Nisha Duggal

  2. Department of Immunopathology, Post Graduate Institute of Medical Research and Education, Chandigarh, PIN-160012, India

    Mahendra Kumar

  3. Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Research and Education, Chandigarh, PIN-160012, India

    Pankaj Malhotra & Arihant Jain

  4. Department of Immunopathology, Post Graduate Institute of Medical Research and Education, Room No: 19, Fourth Floor, Block-A, PGIMER, Chandigarh, PIN-160012, India

    Ritu Aggarwal

Authors
  1. Nisha Duggal
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  2. Mahendra Kumar
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  3. Pankaj Malhotra
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  4. Arihant Jain
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  5. Ritu Aggarwal
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Correspondence to Ritu Aggarwal.

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Duggal, N., Kumar, M., Malhotra, P. et al. Occurrence of Monoclonal Band in Alpha Region on Serum Electrophoresis in Multiple Myeloma: A Diagnostic Conundrum. Indian J Hematol Blood Transfus (2024). https://doi.org/10.1007/s12288-024-01793-z

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  • DOI: https://doi.org/10.1007/s12288-024-01793-z

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