Multiple myeloma: a case of atypical presentation on protein electrophoresis

Abstract

Multiple myeloma is a group of B-cell disorders resulting in the secretion of a specific and unique monoclonal immunoglobulin (M-protein). Protein electrophoresis is advised whenever multiple myeloma is suspected. The monoclonal protein migrates as a single entity in the electric field and is detected by the non-specific protein stain as a more intensely stained band superimposed on the usual protein pattern. The M-protein usually migrates in the gamma or beta region of the normal protein pattern; very rarely it may appear in the α2 or even in α1 region. Here we have given an atypical case presentation where the patient with multiple myeloma presented with two M-spike one each in α2 and β-globulin region on agarose gel protein electrophoresis with hypoglobulinemia but with reversed A:G ratio.

Keywords: Agarose gel protein electrophoresis; Biclonal gammopathy; Immunofixation electrophoresis; M-protein; Multiple myeloma.

Fig. 1

Agarose gel protein electrophoresis shows hypoalbuminemia with gross increase in alpha-2 and beta globulins. The two spikes seen in the scan corresponds to alpha-2 and beta globulins regions

Fig. 2

Immunofixation electrophoresis reveals two dense bands in SP region. The two bands immunologically correspond to two IgA-κ bands