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An IgE multiple myeloma: contradictory findings in clinical laboratory testing
Sara Altinier1, Giuseppina Barberio, Mariacristina Varagnolo
1Department of Laboratory Medicine, University-Hospital of Padova, Italy.
Insights
This study reports a rare case of IgE multiple myeloma with conflicting lab results. Immunometric tests detected urine IgE, but immunofixation did not, suggesting IgE modification during renal filtration.
Area of Science:
- Clinical Chemistry
- Immunology
- Hematology
Background:
- IgE multiple myeloma is a rare and aggressive plasma cell disorder requiring accurate laboratory diagnosis for targeted therapy.
- This paper details a specific case of IgE myeloma presenting with discordant laboratory findings between different diagnostic techniques.
Observation:
- Serum immunofixation identified an IgE lambda monoclonal band with high serum IgE levels (1,364,00 kU/L).
- Urine electrophoresis showed a band consistent with IgE, and urine IgE concentration was elevated (2715 kU/L).
- However, urine sample immunofixation failed to detect any IgE-reactive band.
Findings:
- Discrepancy noted between immunometric quantification and immunofixation for urine IgE.
- The immunometric assay detected IgE in urine, while immunofixation did not, despite electrophoretic evidence of an IgE-like band.
Implications:
- The findings suggest potential modification of IgE during renal filtration or within the urine matrix.
- Such modifications may affect the epitope recognized by antisera in immunofixation, but not in immunometric assays.
- This highlights the importance of considering assay-specific methodologies when interpreting results in complex cases like IgE myeloma.
Background:
IgE multiple myeloma is a rare kind of plasma cell disorder, characterized by an aggressive clinical course, where laboratory testing plays a fundamental role for the correct diagnosis in order to start a targeted therapy. In the present paper it is described a case of IgE myeloma where contradictory findings between immunometric and separative techniques were found.
Materials And Methods:
Serum and 24h urine samples were tested using electrophoresis and immunofixation electrophoresis employing IgE antiserum and IgE were quantified using an immunometric method.
Results:
Serum immunofixation evidenced a monoclonal band ascribable to IgE lambda and IgE serum concentration was 1,364,00 kU/L. Urine electrophoresis evidenced a band compatible with IgE, and urine concentration was 2715 kU/L. On the contrary in the immunofixation of the urine sample no band reacting with IgE antiserum was found.
Conclusions:
Considering that the immunometric method measured IgE in urine sample and the electrophoresis of urine sample evidenced a band compatible with IgE, the explanation could be that during renal filtration or because of some characteristics related to urine matrix, the immunoglobulin IgE could had been modified in the site recognized by the antiserum used in immunofixation, and not in the one used in the immunometric method.
