Test Id : FHLCG
Immunoglobulin G (IgG) 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 IgG proteins that are difficult to quantitate using serum protein electrophoresis alone.
3. Providing a more specific quantitation of the monoclonal protein than total IgG measurements alone.
Method Name
A short description of the method used to perform the test
Turbidimetric
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Hevylite IgG
HLC IgG
IgG Kappa:Lambda HLC Ratio
Specimen Type
Describes the specimen type validated for testing
Serum
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Specimen Type: Serum
Container/Tube: Red top or SST
Specimen Volume: 0.75 mL
Collection Instructions: Draw blood in a plain red-top tube, serum gel tube(s) is also acceptable. Separate serum immediately after coagulation (30 minutes) to prevent hemolysis. Send 0.75 mL of serum refrigerated in a plastic vial.
NOTE: Patient should be fasting for eight hours to avoid lipemic sample interference.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild reject; Gross reject |
| Lipemia | Mild reject; Gross reject |
| Icterus | NA |
| Other | Microbially-contaminated specimen; specimen containing particulate matter |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 14 days | |
| Ambient | 14 days | ||
| Frozen | 14 days |
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 IgG proteins that are difficult to quantitate using serum protein electrophoresis alone.
3. Providing a more specific quantitation of the monoclonal protein than total IgG 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, and other lymphoproliferative disorders. International guidelines recommend serum protein electrophoresis or nephelometric immunoglobulin quantification as tools to monitor patients' disease (alongside other tests including flow cytometry and serum free light chain analysis). Total IgG nephelometric assays will include nontumor immunoglobulin, and measurement of either IgG Kappa or IgG Lambda may give a more accurate representation of tumor production.
Furthermore, measurement of both IgG Kappa and IgG Lambda, calculation of the IgG Kappa:IgG Lambda ratio, and comparison with values found in normal subjects can give a more sensitive indication of clonality. Additionally, changes in the IgG Kappa:IgG Lambda ratio and its normalization when compared to a normal ratio range should assist in monitoring patients' disease. Use of the IgG Kappa:IgG Lambda ratio will also compensate for any changes in plasma volume and correct for half life variations due to receptor saturation.
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.
IgG Kappa (g/L): 4.03 - 9.78
IgG Lambda (g/L): 1.97 - 5.71
IgG Kappa:IgG Lambda ratio: 0.98 - 2.75
Interpretation
Provides information to assist in interpretation of the test results
An elevated IgG heavy and light chain (HLC) pair ratio suggests a clonal proliferation of an IgG Kappa clone of plasma cells.
A low IgG HLC pair ratio suggests a clonal proliferation of an IgG 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 IgG Kappa, IgG Lambda, or IgG Kappa:IgG 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 IgG Kappa and IgG Lambda by this assay has not been evaluated.
Small increases in the concentrations of monoclonal IgG proteins may not result in an altered HLC pair ratio.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Dimopoulos M, Kyle R, Fermand JP, et al. Consensus recommendations for standard investigative workup: Report of the International Myeloma Workshop Consensus Panel 3. Blood. 2011 May 5; 117(18):4701-4705. PubMed 21292778
2. Rajkumar SV, Harousseau JL, Durie B, et al. Concensus recommendations for the uniform reporting of clinical trials: Report of the International Myeloma Workshop Consensus Panel 1. Blood. 2011 May 5; 117(18):4691-4695. PubMed 21292775
3. Bradwell AR, Harding SJ, Fourrier NJ, et al. Assessment of monoclonal gammopathies by nephelometric measurement of individual immunoglobulin kappa/lambda ratios. Clin. Chem. 2009 Sep; 55(9):1646-1655. PubMed 19617289
4. Ludwig H, Milosavljevic D, Zojer N, et al. Immunoglobulin heavy/light chain ratios improve paraprotein detection and monitoring, identify residual disease and correlate with survival in multiple myeloma patients. Leukemia. 2013 Jan; 27(1):213-219. PubMed 22955329
5. Bradwell A, Harding S, Fourrier N, et al. Prognostic utility of intact immunoglobulin Ig'?/Ig'? ratios in multiple myeloma patients. Leukemia. 2013 Jan; 27(1):202-207. PubMed 22699454
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Tuesday, Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
83883 x 2
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| FHLCG | IgG Heavy Light Chains (HLC), S | 74773-3 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| Z5613 | IgG Kappa, S | 74862-4 |
| Z5614 | IgG Lambda, S | 74863-2 |
| Z5615 | IgG K/L HLC Ratio | 74868-1 |