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.
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).
Hemoglobin C, D Punjab, E or S trait can interfere with hemoglobin A1c (HbA1c) results depending on the method of analysis used. Therefore, it is important to know the limitations of the method used for HbA1c determination.
Immunotherapies for Multiple Myeloma, like the monoclonal antibody daratumumab, can create false positive IgG Kappa bands on Immunofixation gels. This paper describes best practice guidelines for using the Hydrashift assay to remove daratumumab interference from Immunofixation gels.
This article assesses the performances of the different manufacturers and technologies (HPLC and CE) for Hb A2 measurement using both International Reference Reagent for HbA2 (WHO IRR 89/666) and analysis of three whole blood specimens over a range of HbA2, distributed to 56 laboratories located in 14 different countries.
The « 20 » and « 100 » Ratios Cut-off can be used in routine with Sebia FLC assays for high-risk smoldering multiple myeloma stratification and for assessing progression to active multiple myeloma or amyloidosis.
This article reminds the reader of the importance of detecting the Hb variants when measuring HbA1c for the labs and clinicians to better interpret the results and to ensure optimal management of the diabetic patient.