Procedures for the evaluation of monoclonal immunoglobulins

A wide variety of techniques are available for the screening, characterization, and quantification of monoclonal proteins. These techniques vary in regard to the expense, skill and intensity of labor involved, and sensitivity for detection of low levels of monoclonal proteins or of those with unusual migration. Detection of monoclonal proteins requires the use of high-resolution electrophoresis (either gel-based or capillary) and immunofixation (or immunosubtraction). Immunoelectrophoresis is not recommended. Urine for detection of monoclonal free light chains should be from 24-hour samples, and the aliquot should be concentrated at least 100-fold prior to electrophoresis and immunofixation. Dipstick and sulfosalicylic acid techniques are not sensitive enough to detect small quantities of monoclonal free light chains and should not be used as screening tests for this purpose.