Detecting or monitoring of monoclonal gammopathies and immune deficiencies
IgA, IgG, IgM (Immunoglobulins A, G, M)
Immunoglobulin Panel, Serum
Quant Ig, Serum
Immunoglobulin G (IgG)
Immunoglobulin M (IgM)
Immunoglobulin A (IgA)
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Client Test Request (T728) with the specimen.
|Specimen Type||Temperature||Time||Special Container|
|Serum||Refrigerated (preferred)||28 days|
Detecting or monitoring of monoclonal gammopathies and immune deficiencies
The gamma globulin band as seen in conventional serum protein electrophoresis consists of 5 immunoglobulins. In normal serum, about 80% is IgG, 15% is IgA, 5% is IgM, 0.2% is IgD, and a trace is IgE.
Elevations of IgG, IgA, and IgM may be due to polyclonal immunoglobulin production.
Monoclonal gammopathies of all types may lead to a spike in the gamma globulin zone seen on serum protein electrophoresis. Monoclonal elevations of IgG, IgA, IgD, and IgE characterize multiple myeloma. Monoclonal elevations of IgM occur in macroglobulinemia.
Decreased immunoglobulin levels are found in patients with congenital deficiencies.
0-<5 months: 100-334 mg/dL
5-<9 months: 164-588 mg/dL
9-<15 months: 246-904 mg/dL
15-<24 months: 313-1,170 mg/dL
2-<4 years: 295-1,156 mg/dL
4-<7 years: 386-1,470 mg/dL
7-<10 years: 462-1,682 mg/dL
10-<13 years: 503-1,719 mg/dL
13-<16 years: 509-1,580 mg/dL
16-<18 years: 487-1,327 mg/dL
> or =18 years: 767-1,590 mg/dL
IgA 0-<5 months: 7-37 mg/dL 5-<9 months: 16-50 mg/dL 9-<15 months: 27-66 mg/dL 15-<24 months: 36-79 mg/dL 2-<4 years: 27-246 mg/dL 4-<7 years: 29-256 mg/dL 7-<10 years: 34-274 mg/dL 10-<13 years: 42-295 mg/dL 13-<16 years: 52-319 mg/dL 16-<18 years: 60-337 mg/dL > or =18 years: 61-356 mg/dL IgM 0-<5 months: 26-122 mg/dL 5-<9 months: 32-132 mg/dL 9-<15 months: 40-143 mg/dL 15-<24 months: 46-152 mg/dL 2-<4 years: 37-184 mg/dL 4-<7 years: 37-224 mg/dL 7-<10 years: 38-251 mg/dL 10-<13 years: 41-255 mg/dL 13-<16 years: 45-244 mg/dL 16-<18 years: 49-201 mg/dL > or =18 years: 37-286 mg/dL
0-<5 months: 7-37 mg/dL
5-<9 months: 16-50 mg/dL
9-<15 months: 27-66 mg/dL
15-<24 months: 36-79 mg/dL
2-<4 years: 27-246 mg/dL
4-<7 years: 29-256 mg/dL
7-<10 years: 34-274 mg/dL
10-<13 years: 42-295 mg/dL
13-<16 years: 52-319 mg/dL
16-<18 years: 60-337 mg/dL
> or =18 years: 61-356 mg/dL
0-<5 months: 26-122 mg/dL
5-<9 months: 32-132 mg/dL
9-<15 months: 40-143 mg/dL
15-<24 months: 46-152 mg/dL
2-<4 years: 37-184 mg/dL
4-<7 years: 37-224 mg/dL
7-<10 years: 38-251 mg/dL
10-<13 years: 41-255 mg/dL
13-<16 years: 45-244 mg/dL
16-<18 years: 49-201 mg/dL
> or =18 years: 37-286 mg/dL
Increased serum immunoglobulin concentrations occur due to polyclonal or oligoclonal immunoglobulin proliferation in hepatic disease (eg, hepatitis, liver cirrhosis), connective tissue diseases, acute and chronic infections, as well as in the cord blood of neonates with intrauterine and perinatal infections.
Elevations of IgG, IgA, or IgM may occur in monoclonal gammopathies such as multiple myeloma (IgG, IgA), macroglobulinemia (IgM), primary systemic amyloidosis, monoclonal gammopathy of undetermined significance, and related disorders.
Decreased levels are found in patients with primary or secondary immune deficiencies.
Electrophoresis is usually required to interpret an elevated immunoglobulin class as polyclonal versus monoclonal. Immunofixation is usually required to characterize a monoclonal protein.
If there is a discrete M-peak, the monoclonal protein can be monitored with quantitative immunoglobulins. If immunoglobulin quantitation is used to monitor the size of a monoclonal protein that is contained in a background of polyclonal immunoglobulins, changes in the immunoglobulin quantitation may reflect changes in the background immunoglobulins. In these situations, serum protein electrophoresis should therefore be used to monitor the monoclonal protein.
Results determined by assays using different manufacturers or methods may not be comparable.
1. Webster ADB: Laboratory Investigation of primary deficiency of the lymphoid system. In: Clinics in Immunology and Allergy. Vol 5. 3rd ed. WB Saunders Company; 1985:447-468
2. Pinching AJ: Laboratory investigation of secondary immunodeficiency. In: Clinics in Immunology and Allergy. Vol.5. 3rd ed. WB Saunders Company; 1985:469-490
3. Dispenzieri A, Gertz MA, Kyle RA: Distribution of diseases associated with moderate polyclonal gammopathy in patients seen at Mayo Clinic during 1991. Blood 1997;90:353
4. Kyle RA, Greipp PR: The laboratory investigation of monoclonal gammopathies. Mayo Clin Proc. 1978 Nov;53(11):719-739
5. Ballow M, O'Neil KM: Approach to the patient with recurrent infections. In: Middleton Jr E, Reed CE, Ellis EF, et al, eds. Allergy: Principles and Practice. Vol 2. 4th ed. Mosby-Year Book, Inc; 1993:1027-1058
6. Kyle RA: Detection of quantitation of monoclonal proteins. Clin Immunol Newsletter. 1990;10:84-86
7. Dietzen DJ, Willrich MAV: Amino acids, peptides, and proteins. In: Rifai N, Chiu RWK, Young I, Burnham CAD, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 31
In this Siemens Nephelometer II method, the light scattered onto the antigen-antibody complexes is measured. The intensity of the measured scattered light is proportional to the amount of antigen-antibody complexes in the sample under certain conditions. If the antibody volume is kept constant, the signal behaves proportionally to the antigen volume.
A reference curve is generated by a standard with a known antigen content on which the scattered light signals of the samples can be evaluated and calculated as an antigen concentration. Antigen-antibody complexes are formed when a sample containing antigen and the corresponding antiserum are put into a cuvette. A light beam is generated with a light emitting diode, which is transmitted through the cuvette. The light is scattered onto the immuno-complexes that are present. Antigen and antibody are mixed in the initial measurement, but no complex is formed yet. An antigen-antibody complex is formed in the final measurement.
The result is calculated by subtracting the value of the final measurement from the initial measurement. The distribution of intensity of the scattered light depends on the ratio of the particle size of the antigen-antibody complexes to the radiated wavelength.(Instruction manual: Siemens Nephelometer II, Siemens, Inc.; Version 3, 2008; Addendum to the Instruction Manual 2.3, 08/2017)
Monday through Friday
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.
82784 x 3
|Test Id||Test Order Name||
Order LOINC Value
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.
|IMMG||Immunoglobulins IgG,A,M, S||34550-4|
|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.
|IGA||Immunoglobulin A (IgA), S||2458-8|
|IGG||Immunoglobulin G (IgG), S||2465-3|
|IGM||Immunoglobulin M (IgM), S||2472-9|