γ/IgG ratio: role in distinguishing monoclonal spikes from fibrinogen

Serum protein electrophoresis (SPEP) is a standard screening method for detecting monoclonal gammopathies. Presence of fibrinogen, however, can mimic a true monoclonal spike and interfere with accurate monoclonal protein identification. We describe a novel approach for distinguishing fibrinogen spikes from true monoclonal spikes. We classified 600 individual patient samples into four groups: group 1, 58 samples with a fibrinogen spike; group 2, 127 samples with a spike due to a monoclonal gammopathy; group 3, 181 samples with previously established monoclonal gammopathies but resolved posttreatment; and group 4, 234 control samples without monoclonal gammopathies. The value of using a γ region fraction/IgG ratio in distinguishing fibrinogen from true monoclonal spikes was assessed. The γ/IgG ratio in the fibrinogen group is significantly (P<0.0001) higher than this ratio in the other three groups. A γ/IgG ratio cut-off value of 1.13 discriminates true monoclonal gammopathies from fibrinogen. Moreover, exclusion of elevated IgA or IgM cases improves the ratio's predictive power. The probability cut-off is 0.756, corresponding to a γ/IgG ratio of 1 (93% sensitivity, 91% specificity). Using the γ/IgG ratio improves the screening power of SPEP and offers a simple and reliable diagnostic tool for distinguishing fibrinogen spikes from true monoclonal spikes.