Usefulness of serum globulin levels for discriminating patients with monoclonal gammopathies/ paraproteinemias
Keywords:Monoclonal gammopathies, paraproteinemia, serum globulin, M-protein, SPE
Introduction and Aim: The confirmatory step in diagnosis of monoclonal gammopathies is bone marrow biopsy and presence of M-protein in serum protein electrophoresis. These tests are relatively expensive & invasive for screening and unavailable in low resource settings. Increased levels of serum globulin are clue to the diagnosis of monoclonal gammopathy. The aim of this study was to assess the relevance of serum globulin levels in discriminating between patients with & without monoclonal gammopathies/ paraproteinemia.
Materials and Methods: We retrospectively reviewed serum protein electrophoresis (SPE) and related investigations of patients suspected of monoclonal gammopathy. Reports with an M-band were considered as paraproteinemias, and those without as controls. ROC for sensitivities & specificities for serum globulin levels were computed.
Results: For the case-control study, median serum globulin values in cases were 4.4 (3.5-6.3) g/dL in males and 3.65 (3.33-5.0) g/dL in females. They were significantly higher than those with normal SPE pattern, with a p <0.001. A cut-off value of 3.25 g/dL of globulin could distinguish between paraproteinemias and controls with a sensitivity of 82.1% and specificity of 85.4% in males; a sensitivity of 79.2%, a specificity of 76.7% for females. At a cut-off value of 3.4 g/dL, sensitivity was 77% and specificity 92.7% for males; sensitivity was 75% and specificity 83.7% for females. Alternatively, a cut-off value of 0.458 of globulin/total protein ratio could distinguish at a best sensitivity & specificity of 80% and 89% in males; 83.3% and 83.7% in females.
Conclusion: Serum globulin values and globulin/total protein ratio can reliably differentiate patients with paraproteinemias.
Tate, J.R. The paraprotein - An enduring biomarker. Clin Biochem Rev. 2019;40(1):5-22.
Rosen, S.T., Roccaro, A.M., Ghobrial, I.M. Plasma cell dyscrasias. Cancer Treatment and Research; 2016. Available from: https://www.springer.com/gp/book/9783319403182
Hultcrantz, M., Morgan, G.J., Landgren, O. Multiple myeloma and other plasma cell dyscrasias [Internet]. Oncologic Therapies. 2017. 489–507 p. Available from: https://link.springer.com/content/pdf/10.1007%2F978-3-319-25586-6.pdf
Bornhorst, J. Protein marker evaluation of monoclonal gammopathies. Clin Lab News. 2015;1-7.
Tripathy, S. The role of serum protein electrophoresis in the detection of multiple myeloma: An experience of a corporate hospital. J Clin Diagnostic Res. 2012;6(9):1458-1461.
Chan, P.C., Yasodhara, A., Truong, D. Bisalbuminemia?: Lack of association with monoclonal gammopathy and value-justification for reporting in serum protein electrophoresis. J Clin Chem Lab Med. 2017;1(1):1-4.
J, R.B., Sharma, B.K., Furruqh, S. A study to evaluate immunoglobulins fraction by serum protein electrophoresis for occurrence of multiple myeloma in a tertiary care hospital. Int J Biomed Res. 2017;8(7):397-403.
Loprinzi, P.D., Addoh, O. The gamma gap and all-cause mortality risk: considerations of physical activity. Int J Clin Pract. 2016;70(7):625-629.
Busher, J.T. Serum albumin and globulin. clin methods hist phys lab exam. 1990; Available from: http://www.ncbi.nlm.nih.gov/pubmed/21250048
Sakalova, A., Holomanova, D., Mistrik, M., Hrubiško, M., Gažová, S., Chabro?ová, I.,et al., Current problems of early recognition of primary malignant monoclonal gammopathy. [Slovak]. Lekarsky Obzor. 2004; 53 (5):177-183
Eslick, R., Talaulikar, D. Multiple myeloma: from diagnosis to treatment. Aust Fam Physician. 2013;42(10):684–8. Available from: https://www.racgp.org.au/download/Documents/AFP/2013/Oct/201310eslick.pdf
Eren, R., Ozdemir, O., Aslan, C., Dogu, M., Altindal, S. and Yokus, O.,et al., The association of globulin levels with treatment response and survival in multiple myeloma patients. Eurasian J Med Oncol. 2017; 22):61-64.
Gupta, R., Dahiya, M., Kumar, L., Shekhar, V., Sharma, A., Ramakrishnan, L.,et al., Prevalence of monoclonal gammopathy of undetermined significance in India—A hospital-based study. Clin Lymphoma, Myeloma Leuk. 2018;18(9):e345-350.
Singh, K., Singh, B., Arora, S., Saxena, A. Immunological evidence of monoclonal gammopathy in North India: a hospital based study. Pathol Lab Med Int. 2010;107.
Bora, K. Distribution of multiple myeloma in India: Heterogeneity in incidence across age, sex and geography. Cancer Epidemiol. 2019;59:215-220. doi:10.1016/j.canep.2019.02.010
Shaft, M., Zargar, M., Shah, Z.A.,Salahuddin, M., Siddiqi, M., An immunological based study of monoclonal gammopathies among suspected individuals in Kashmir region. Indian J Clin Biochem. 1998;13(2):106-110.
Thakkinstian, A., Tran, H., Reeves, G.,Murch, S., Attia, J.,A clinical decision rule to aid ordering of serum and urine protein electrophoresis for case-finding of paraproteins in hospitalized inpatients. J Gen Intern Med. 2008;23(10):1688-1692.
Mitchell, E.B., Ali, M.A.M., Keane, P.,Bienenstock, J.,The value of elevated gamma globulins in the diagnosis of monoclonal gammopathy and multiple myeloma. Ir J Med Sci. 1983;152(9):349-352.
Yang, M., Xie, L., Liu, X.,Hao, Q., Jiang, J., Dong, B., et al.,The gamma gap predicts 4-year all-cause mortality among nonagenarians and centenarians. Sci Rep. 2018;8(1):4-9. https://doi.org/10.1038/s41598-018-19534-4.
Kapoor, R., Kumar, R., Dubey, A.P. Risk stratification in multiple myeloma in Indian settings. Indian J Hematol Blood Transfus. 2020;36(3):464-472. doi:10.1007/s12288-019-01240-4.
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.