By Orthopaedics resident .

1. Electrophoresis and
Immunofixation
Dr. Subhash Kumar Das
Resident
Department of Orthopaedics
SBH

2. Serum Proteins
 A/G : 1.5 :1

3. Acute phase proteins(APR)
Their concentration changes in acute
inflammatory response
 Infections
 Surgery
 Injury
 Cancer

4. Types of APRs
• Positive
 Alpha1 antitrypsin
 C-reactive protein(1000
fold increase)
 Fibrinogen
 Haptoglobulin
 C3, C4
• Negative
 Albumin
 Transferrin

5. Electrophoresis : why the hype ??

6. Electrophoresis
Electrical Separation
Apheresis : taking away
eg . Plasmapheresis
leukopheresis

7. Separates component of plasma protein ( -vely
charged)

8. Plasma cell dyscrasias (monoclonal gammopathy)
Only one entity
“single antibody”
Gammaglobulin
Pathology
But there is one problem :
We don’t know
Which subtype of gammaglobin is high
(eg : IgG , IgM , IgA…) ( eg: Kappa , lambda)

9. So, how to solve the problem ?

10. Please welcome Immuno electrophoresis
( Immunofixation)
We add antibodies to antigen : anti-A ,
Anti-G, Anti-M , Anti-kappa , anti-lambda

11. Immunoelectrophoresis(immunofixation)
Interpretation
IgG lambda
monoclonal protein is
Present in serum.

12. Connecting the dots

13. we saw 70 yrs/m with bone pain( back and ribs) , his calcium level and cretinine level were
high , so we ordered serum electrophoresis and immunofixation

14. Multiple
myeloma
Monoclonal
gammopathy

15. What is Multiple myeloma ?
• Cancer of Plasma cells.
• Malignant B cell lymphoproliferative disorder
of marrow with plasma cell predominating.
• Most common primary malignancy of bone.

18. The most accurate test to diagnose multiple myeloma is
bone marrow biopsy