Detection of serum free light chains: the problem with antigen excess

Clinical Chemistry and Laboratory Medicine : CCLM
Markus BosmannUdo Steigerwald

Abstract

In recent years, measurement of serum immunoglobulin free light chains (FLCs) has greatly facilitated diagnosis and monitoring of various plasma cells dyscrasias, including multiple myeloma. Detection of FLCs by nephelometry depends on the formation of immune complexes. However, it is known that if the antigen (free light chain) is present in great excess, non-precipitating immune complexes can be formed and be detected poorly. This may lead to inaccurate test results. Serum samples from 91 patients were subjected prospectively to the detection of free κ and λ light chains by automated nephelometry. A standard dilution of 1:100 was paralleled by a 1:2000 dilution. In addition, samples with values below the effective range (1:100) were subjected to a 1:20 dilution in order to calculate the κ/λ ratio. Here, we report the incidence of antigen excess in a cohort of 91 patients with a high proportion of monoclonal abnormalities. A standard dilution (1:100) of free light κ chains from a patient with monoclonal immunoglobulin A κ gammopathy were missed repeatedly. In a second patient (with myeloproliferative disease and an apparent incidental FLC monoclonal gammopathy of undetermined significance) free λ chains were also substantially...Continue Reading

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Citations

Feb 16, 2013·F1000 Medicine Reports·Judith A Brebner, Robert A Stockley
Mar 10, 2015·Clinica Chimica Acta; International Journal of Clinical Chemistry·Martine J VercammenXavier Bossuyt
Jan 27, 2016·Clinical Chemistry and Laboratory Medicine : CCLM·Maria Stella Graziani
Jan 31, 2012·Clinica Chimica Acta; International Journal of Clinical Chemistry·Ellen JennerStephen Harding
Mar 5, 2016·Clinical Chemistry and Laboratory Medicine : CCLM·Hugh D Carr-SmithStephen J Harding
Dec 8, 2015·Clinical Chemistry and Laboratory Medicine : CCLM·Joannes F M JacobsGiampaolo Merlini
Mar 25, 2016·Clinical Chemistry and Laboratory Medicine : CCLM·Henk Te VelthuisJohn P Campbell
Jul 6, 2014·Biotechnology and Bioengineering·Judith Zhu-ShimoniMartin Vanderlaan
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Jul 10, 2014·Scandinavian Journal of Clinical and Laboratory Investigation·Petter UrdalOlav Klingenberg
Jul 12, 2011·Clinica Chimica Acta; International Journal of Clinical Chemistry·Martine VercammenXavier Bossuyt
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Oct 28, 2018·Clinical Chemistry and Laboratory Medicine : CCLM·Dietmar Enko, Gernot Kriegshäuser
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