TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: FHLC    
Immunoglobulin M (IgM) Heavy and Light Chain (HLC) Pairs, Kappa and Lambda with Ratio

Useful For Suggests clinical disorders or settings where the test may be helpful

Heavy and light chain pair quantitation may be useful for:

1. Distinguishing between broadly migrating monoclonal proteins and restricted polyclonal immunoglobulin patterns on serum electrophoresis. 

2. Quantitating monoclonal IgM proteins that are difficult to quantitate using serum protein electrophoresis alone.

3. Providing a more specific quantitation of the monoclonal protein than total IgM measurements alone.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Elevated serum concentrations of monoclonal protein are indicative of an underlying abnormality, such as monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma, Waldenström's macroglobulinemia and other lymphoproliferative disorders. Serum protein electrophoresis (SPE) densitometry is recommended to quantify monoclonal proteins.

 

Nephelometry can also be used in these instances to measure total IgM, but this will include nontumor immunoglobulin, and measurement of either IgM Kappa or IgM Lambda may provide additional information regarding tumor production.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

IgM Kappa (g/L): 0.29-1.82

IgM Lambda (g/L): 0.17-0.94

IgM Kappa:IgM Lambda ratio: 0.96-2.30

Interpretation Provides information to assist in interpretation of the test results

An elevated IgM heavy and light chain (HLC) pair ratio suggests a clonal proliferation of an IgM kappa clone of plasma cells.

A low IgM HLC pair ratio suggests a clonal proliferation of an IgM lambda clone of plasma cells.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Decisions on patient evaluation and management must not be given on the basis of IgM Kappa, IgM Lambda, or IgM Kappa:IgM Lambda ratio measurements alone. Clinical history and other laboratory findings must be taken into account.

Heavy and light chain (HLC) quantitation should be used as a complementary method to serum protein electrophoresis.

The effect of therapeutic drugs on the measurement of IgM Kappa and IgM Lambda by this assay has not been evaluated.

Small increases in the concentrations of monoclonal IgM proteins may not result in an altered HLC pair ratio.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Smith A, Wisloff F, Samson D; UK Myeloma Forum; Nordic Myeloma Study Group; British Committee for Standards in Haematology. (2005) Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haematol. 2006 Feb; 132(4):410-451. PubMed 16412016

2. Bradwell AR, Harding S, Drayson M, Mead G. Novel nephelometric assays give a sensitive measure of residual disease in multiple myeloma (MM). Br J Haematol. 2008; 141(s1):39. Abstract 107.

3. Kyle RA, Rajkumar SV. Monoclonal gammopathies of undetermined significance: A review.Immunol Rev. 2003 Aug; 194:112-139. PubMed 12846812