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Monoclonal Gammopathy

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As described elsewhere (Chapter 29: The Lymphoid System: II. Malignant Lymphomas), neoplastic proliferations of B lymphocytes are demonstrably monoclonal; if plasmacytoid differentiation occurs, the neoplastic cells may secrete immunoglobulin that will accumulate in the serum and produce a monoclonal spike on electrophoresis, or M protein. The terms monoclonal gammopathy and plasma cell dyscrasia are employed synonymously for disorders in which a monoclonal spike is present in serum. Most conditions associated with monoclonal gammopathy (Table 30-1) show evidence of proliferation of plasma cells or plasmacytoid cells—hence the term plasma cell dyscrasia. It is important to distinguish the forms of monoclonal gammopathy that are malignant because they require treatment.

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Table 30–1. Causes of Monoclonal Gammopathy*.
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Diagnosis

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Serum Protein Electrophoresis
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The serum contains numerous proteins that may be separated by electrophoresis according to differences in size and charge. Protein molecules are allowed to migrate on special paper or in a gel under the influence of an electrical field. Identical molecules migrate to an identical point within the field, and each different protein accumulates at a characteristic point under specified conditions (Figure 30-1). Protein accumulations, or bands, may be visualized by staining and quantitated by densitometry: The higher the density of the band, the more protein is present.

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Figure 30–1.
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Serum protein electrophoresis. In normal individuals, all molecules of albumin are identical in charge and molecular weight and therefore accumulate in one narrow band on electrophoresis. Because the ...

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