What is your approach to a patient who is referred for an immunofixation showing a “faint band” of monoclonal IgG kappa or IgG lambda?

Professor of Laboratory Medicine & Pathology and professor of Medicine at the Mayo Clinic in Rochester, Minnesota

This month, Robert A. Kyle, MD, answers a question about the “faint monoclonal band” of IgG kappa or IgG lambda in a dense polyclonal background.

CLINICAL DILEMMA

What is your approach to a patient who is referred for an immunofixation showing a “faint band” of monoclonal IgG kappa or IgG lambda in a dense polyclonal background with or without an increase of that involved heavy chain?

EXPERTS MAKE THE CALL

If it is increased, I would not be concerned about the faint band and simply follow with a repeat electrophoresis and immunofixation in six months. The small monoclonal protein may disappear or another small monoclonal protein may appear.

If it persists and is still stable, I would simply repeat the tests at annual intervals. Further evaluation such as bone marrow examination, skeletal x-rays, etc. are not necessary.

As you know, patients with a polyclonal increase in immunoglobulins have an inflammatory or reactive process. The most common causes for these processes in patients living in the United States today are connective tissue disorders or chronic liver disease, whereas in other parts of the world tuberculosis and other infectious diseases may be major causes.

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