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Multiple Myeloma Cascade With Reflex to sIFE and sFLC

CPT 84155; 84165

Test Details

Turnaround Time

3 - 5 days

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Use

To maximize the clinical sensitivity of Serum Protein Electrophoresis (SPEP) when screening for plasma cell dyscrasias.

Test Includes

A Serum Protein Electrophoresis (SPEP) test is first run. If the SPEP is:

1. Positive (i.e., M-Protein present), a serum Immunofixation (sIFE) test is automatically ordered and run (at additional charge). This reflexed test serves to identify the M-protein's heavy and light chain components (e.g., "IgG Kappa"). This finding will be reported and no further reflex testing will occur.

2. Negative (i.e., no M-Protein seen), a serum Free Light Chain (sFLC) test is automatically ordered and run (at additional charge). Then:

• If the sFLC is Positive (i.e., abnormal K/L ratio), a serum Immunofixation (sIFE) test is automatically ordered and run (at additional charge). This reflexed test serves to identify the M-protein's heavy and light chain components (e.g., "IgG Kappa"). This finding will be reported and no further reflex testing will occur.

• If the sFLC is Negative (i.e., no abnormal K/L ratio), no further reflex testing will occur. A recommendation comment will be added to the report to "Consider ordering urine Immunofixation (uIFE) to rule out Amyloidosis (AL)."

Methodology

SPEP: Protein electrophoresis on agarose media; IFE: Electrophoresis followed by immunodiffusion against monospecific antisera to immunoglobulin and individual heavy and light chains; Ig Quant: turbidimetric quantitation of IgG, IgA, and IgM; sFLC: turbidimetric quantitation

Related Documents

For more information, please view the literature below.

Multiple Myeloma Cascade With Reflex to sIFE and sFLC

Published Plasma Cell Dyscrasias Selection Table

Additional Information

The analytical sensitivity of the commonly used serum tests for Multiple Myeloma (MM) screening is: SPEP < sIFE < sFLC with SPEP being the least sensitive and sFLC being the most sensitive detector of M-proteins.1

According to the International Myeloma Working Group (IMWG) guidelines, addition of sFLC and IFE to SPEP can prevent false negatives and increases the detection of multiple myeloma to >99%.2

Specimen Requirements

Information on collection, storage, and volume

Specimen

Serum

Volume

5 mL

Minimum Volume

3 mL

Container

Red-top tube or gel-barrier tube

Storage Instructions

Refrigerate at 2°C to 8°C.

Causes for Rejection

Hemolysis; plasma instead of serum

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