Testing for abnormal immunoglobulins was based previously on serum electrophoresis and immunofixation only. In the last years, however, free light chain (FLC) testing in serum became one important pillar in the diagnosis and monitoring of Multiple Myeloma and related disorders such as Amyloidosis, most of these diseases occurring in older patients. In particular, the ratio of κ FLCs to λ FLCs became pivotal in the diagnosis, monitoring, and rule-out of patients with suspected myeloma. The challenge of this serum testing is the heterogeneity of free light chains and other methodical issues of testing which challenge in particular FLC tests based on turbidimetry and nephelometry.

The other challenges arise from the accumulation of FLC in serum due to the impaired excretion of FLC in patients with altered renal function – and renal function will decrease with age physiologically. Since elevated FLC will damage the kidneys, the establishment of reference ranges is challenging, and adequate reference ranges are necessary to obtain good discrimination between patients and normal (healthy) subjects. This webinar will describe the laboratory tests currently used and will suggest methods to establish reference ranges that allow the optimized use of FLC assays.

Speaker’s Biography

Matthias Orth received his training in Clinical Pathology at the universities of Freiburg and Magdeburg (Germany). From 1994-1997 he worked as a postdoctoral fellow at the Gladstone Institutes (GICD) of the University of San Francisco (UCSF). After his employment at the Free University Berlin and at Leipzig University, he became director of the Institute of Laboratory Medicine at Marienhospital Stuttgart in 2004. He is lecturer at the University of Heidelberg, Medical Faculty of Mannheim. He is active in the German Society of Laboratory Medicine as well as in IFCC, with a research focus on laboratory management. Very recently, he became chair of the Task Force Direct to Consumer testing of EFLM (TF-DTCT).


Matthias Orth, MD, PhD
Director, Institute for Laboratory Medicine, Marienhospital Stuttgart & Lecturer, University of Heidelberg, Medical Faculty of Mannheim

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