Peaks and Distortions: Evaluation of Irregularities in Capillary Serum Protein Electrophoresis-An Institutional Experience of 980 Cases From Bihar

Capillary zone electrophoresis (CZE) is an easy to perform technique encompassing a wide range of clinical applications ranging from inflammatory, renal, hepatic, neurological disorders as well as hematological malignancies like Plasma cell neoplasms. The objectives of the study are to explore various patterns of serum protein abnormalities in different medical diseases ranging from systemic disorders to hematological malignancies coming to our institute and to correlate these electrophoretic abnormalities with clinic-hematological and biochemical parameters. The present study was conducted in the Department of Hematology of a tertiary care institute over a period of 20 months. Altogether 980 samples were received for serum protein electrophoresis (SPE) in clinically indicated cases. Detailed clinical history, hematological and biochemical reports were compiled and analyzed with SPE reports. SPE was performed by Minicap Flex piercing fully automated capillary electrophoresis system from Sebia France and results were interpreted. In the present study, out of 980 cases 630 (64.3%) were males and 350 (35.7%) were females with a M: F ratio of 1.9:1. Most of the cases were in the age group of 51–60 years (n-285, 47.4%) followed by 41–50 years (n = 188, 27%). The most common indication for SPE was Chronic kidney disease (CKD) that accounted for 50% of all cases, followed by Plasma cell neoplasms (40%). Acute kidney injury (AKI), nephrotic syndrome (NS), peripheral neuropathy, and unexplained anemia were the other indications. Most common SPE pattern obtained on CZE was that of polyclonal hypergammaglobulinemia accounting to 316 of all cases (32.2%), closely followed by 292 cases of chronic inflammatory pattern (29.7%). Distortion in gamma region was seen in 14.7% cases (145/980). A distinct M spike was seen in 57 cases (5.8%) suggesting a diagnosis of monoclonal gammopathy. A comprehensive look at all the protein fractions, their distortions and peaks along with clinico-biochemical and hematological correlation can help in reaching out to a correct diagnosis.