Free Light Chain Multiple Myeloma: Atypical Appearance on Serum Immunofixation.

IF 0.6 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY

Clinical laboratory Pub Date : 2025-09-01 DOI:10.7754/Clin.Lab.2025.250213

N El Aboudi, Y Ourahma, A Biaz, S El M Idrissi, A Dami, S Bouhsain

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引用次数: 0

Abstract

Background: Light chain multiple myeloma (LCMM) is a malignant hematological disease characterized by bone marrow infiltration by tumor plasma cells and the secretion of monoclonal free light chains (κ or λ). It is often di-agnosed through hypogammaglobulinemia detected by serum protein electrophoresis, followed by immunotyping showing a monoclonal band in free light chains. However, the structure of monoclonal light chains can sometimes complicate laboratory findings.

Methods: The case studied involves a 52-year-old female patient hospitalized for diffuse bone pain and hypercalcemia. Capillary serum protein electrophoresis revealed hypogammaglobulinemia, leading to serum immunofixation (IFE).

Results: IFE showed a wide additional band in κ light chains, with no correspondence to the heavy chain antisera (GAM, D, and E), but similar reactivity with the anti-κ light chain, creating an interpretive challenge. The free light chain assay revealed a very high κ/λ ratio (1,068). Bone marrow examination showed 85% plasma cell infiltration, confirming the diagnosis of LCMM.

Conclusions: This case highlights the diagnostic challenges encountered in certain cases of light chain multiple myeloma and underscores the importance of a multimarker approach combining serum protein electrophoresis, serum immunofixation, and free light chain assays.

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游离轻链多发性骨髓瘤：血清免疫固定表现不典型。

背景：轻链多发性骨髓瘤（LCMM）是一种以肿瘤浆细胞浸润骨髓和分泌单克隆游离轻链（κ或λ）为特征的恶性血液病。通常通过血清蛋白电泳检测低γ球蛋白血症诊断，随后免疫分型显示游离轻链中的单克隆带。然而，单克隆轻链的结构有时会使实验室结果复杂化。方法：本病例涉及一名因弥漫性骨痛和高钙血症住院的52岁女性患者。毛细管血清蛋白电泳显示低γ球蛋白血症，导致血清免疫固定（IFE）。结果：IFE在κ轻链中显示出较宽的附加带，与重链抗血清（GAM， D和E）不对应，但与抗κ轻链具有相似的反应性，这给解释带来了挑战。自由轻链实验显示κ/λ比非常高（1068）。骨髓检查显示85%浆细胞浸润，确诊LCMM。结论：该病例强调了在某些轻链多发性骨髓瘤病例中遇到的诊断挑战，并强调了将血清蛋白电泳、血清免疫固定和游离轻链检测相结合的多标记方法的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical laboratory 医学-医学实验技术

CiteScore

1.50

自引率

0.00%

发文量

494

审稿时长

3 months

期刊介绍： Clinical Laboratory is an international fully peer-reviewed journal covering all aspects of laboratory medicine and transfusion medicine. In addition to transfusion medicine topics Clinical Laboratory represents submissions concerning tissue transplantation and hematopoietic, cellular and gene therapies. The journal publishes original articles, review articles, posters, short reports, case studies and letters to the editor dealing with 1) the scientific background, implementation and diagnostic significance of laboratory methods employed in hospitals, blood banks and physicians'' offices and with 2) scientific, administrative and clinical aspects of transfusion medicine and 3) in addition to transfusion medicine topics Clinical Laboratory represents submissions concerning tissue transplantation and hematopoietic, cellular and gene therapies.