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Multiple Myeloma Cascade With Reflex to sIFE and sFLC

Test Number 123200
Test number copied
CPT 84155; 84165

Test Details

Methodology

SPEP: Protein electrophoresis on agarose media; IFE: Electrophoresis followed by immunodiffusion against monospecific antisera to immunoglobulin and individual heavy and light chains; Ig Quant: turbidimetric quantitation of IgG, IgA, and IgM; sFLC: turbidimetric quantitation

Result Turnaround Time

3 - 5 days

Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.

Related Documents

For more information, please view the literature below.

Multiple Myeloma Cascade With Reflex to sIFE and sFLC

Published Plasma Cell Dyscrasias Selection Table

Test Includes

A Serum Protein Electrophoresis (SPEP) test is first run. If the SPEP is:

1. Positive (i.e., M-Protein present), a serum Immunofixation (sIFE) test is automatically ordered and run (at additional charge). This reflexed test serves to identify the M-protein's heavy and light chain components (e.g., "IgG Kappa"). This finding will be reported and no further reflex testing will occur.

2. Negative (i.e., no M-Protein seen), a serum Free Light Chain (sFLC) test is automatically ordered and run (at additional charge). Then:

• If the sFLC is Positive (i.e., abnormal K/L ratio), a serum Immunofixation (sIFE) test is automatically ordered and run (at additional charge). This reflexed test serves to identify the M-protein's heavy and light chain components (e.g., "IgG Kappa"). This finding will be reported and no further reflex testing will occur.

• If the sFLC is Negative (i.e., no abnormal K/L ratio), no further reflex testing will occur. A recommendation comment will be added to the report to "Consider ordering urine Immunofixation (uIFE) to rule out Amyloidosis (AL)."

Use

To maximize the clinical sensitivity of Serum Protein Electrophoresis (SPEP) when screening for plasma cell dyscrasias.

Footnotes

1. Katzmann, JA. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev. 2009 Aug;30(3):105-111.19841692
2. Dispenzieri A, Kyle R, Merlini G, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia. 2009 Feb;23(2):215-224.19020545

Custom Additional Information

The analytical sensitivity of the commonly used serum tests for Multiple Myeloma (MM) screening is: SPEP < sIFE < sFLC with SPEP being the least sensitive and sFLC being the most sensitive detector of M-proteins.1

According to the International Myeloma Working Group (IMWG) guidelines, addition of sFLC and IFE to SPEP can prevent false negatives and increases the detection of multiple myeloma to >99%.2

Specimen Requirements

Specimen

Serum

Volume

5 mL

Minimum Volume

3 mL

Container

Red-top tube or gel-barrier tube

Stability Requirements

Temperature

Period

Room temperature

3 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Storage Instructions

Refrigerate at 2°C to 8°C.

Causes for Rejection

Hemolysis; plasma instead of serum

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
123200 Multiple Myeloma Cascade 001073 Protein, Total g/dL 2885-2
123200 Multiple Myeloma Cascade 001488 Albumin g/dL 2862-1
123200 Multiple Myeloma Cascade 001489 Alpha-1-Globulin g/dL 2865-4
123200 Multiple Myeloma Cascade 001490 Alpha-2-Globulin g/dL 2868-8
123200 Multiple Myeloma Cascade 001491 Beta Globulin g/dL 2871-2
123200 Multiple Myeloma Cascade 001492 Gamma Globulin g/dL 2874-6
123200 Multiple Myeloma Cascade 001493 M-Spike g/dL 33358-3
123200 Multiple Myeloma Cascade 011052 Globulin, Total g/dL 10834-0
123200 Multiple Myeloma Cascade 011149 A/G Ratio 1759-0
123200 Multiple Myeloma Cascade 011150 Please note: 77202-0
123200 Multiple Myeloma Cascade 123201 Reflex Testing N/A
123200 Multiple Myeloma Cascade 123203 MM Cascade Reflex Storage N/A
123200 Multiple Myeloma Cascade 001498 PDF 11502-2
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code001073
Result Code NameProtein, Total
UofMg/dL
Result LOINC2885-2
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code001488
Result Code NameAlbumin
UofMg/dL
Result LOINC2862-1
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code001489
Result Code NameAlpha-1-Globulin
UofMg/dL
Result LOINC2865-4
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code001490
Result Code NameAlpha-2-Globulin
UofMg/dL
Result LOINC2868-8
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code001491
Result Code NameBeta Globulin
UofMg/dL
Result LOINC2871-2
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code001492
Result Code NameGamma Globulin
UofMg/dL
Result LOINC2874-6
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code001493
Result Code NameM-Spike
UofMg/dL
Result LOINC33358-3
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code011052
Result Code NameGlobulin, Total
UofMg/dL
Result LOINC10834-0
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code011149
Result Code NameA/G Ratio
UofM
Result LOINC1759-0
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code011150
Result Code NamePlease note:
UofM
Result LOINC77202-0
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code123201
Result Code NameReflex Testing
UofM
Result LOINCN/A
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code123203
Result Code NameMM Cascade Reflex Storage
UofM
Result LOINCN/A
Order Code123200
Order Code NameMultiple Myeloma Cascade
Order Loinc
Result Code001498
Result Code NamePDF
UofM
Result LOINC11502-2
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001776 Immunoglobulin G, Qn, Serum mg/dL 2465-3
Reflex 1
Order Code001496
Order NameImmunofixation Reflex, Serum
Result Code001776
Result NameImmunoglobulin G, Qn, Serum
UofMmg/dL
Result LOINC2465-3
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001784 Immunoglobulin A, Qn, Serum mg/dL 2458-8
Reflex 1
Order Code001496
Order NameImmunofixation Reflex, Serum
Result Code001784
Result NameImmunoglobulin A, Qn, Serum
UofMmg/dL
Result LOINC2458-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001792 Immunoglobulin M, Qn, Serum mg/dL 2472-9
Reflex 1
Order Code001496
Order NameImmunofixation Reflex, Serum
Result Code001792
Result NameImmunoglobulin M, Qn, Serum
UofMmg/dL
Result LOINC2472-9
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 149519 Immunofixation Result, Serum 13169-8
Reflex 1
Order Code001496
Order NameImmunofixation Reflex, Serum
Result Code149519
Result NameImmunofixation Result, Serum
UofM
Result LOINC13169-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121138 Free Kappa Lt Chains,S mg/L 36916-5
Reflex 1
Order Code123202
Order NameFree K+L Lt Chains,Qn,S
Result Code121138
Result NameFree Kappa Lt Chains,S
UofMmg/L
Result LOINC36916-5
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121139 Free Lambda Lt Chains,S mg/L 33944-0
Reflex 1
Order Code123202
Order NameFree K+L Lt Chains,Qn,S
Result Code121139
Result NameFree Lambda Lt Chains,S
UofMmg/L
Result LOINC33944-0
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 1
Order Code123202
Order NameFree K+L Lt Chains,Qn,S
Result Code121141
Result NameKappa/Lambda Ratio,S
UofM
Result LOINC48378-4
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 1
Order Code123202
Order NameFree K+L Lt Chains,Qn,S
Result Code121141
Result NameKappa/Lambda Ratio,S
UofM
Result LOINC48378-4
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 1
Order Code123202
Order NameFree K+L Lt Chains,Qn,S
Result Code121141
Result NameKappa/Lambda Ratio,S
UofM
Result LOINC48378-4
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 1
Order Code123202
Order NameFree K+L Lt Chains,Qn,S
Result Code121141
Result NameKappa/Lambda Ratio,S
UofM
Result LOINC48378-4
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 1
Order Code123202
Order NameFree K+L Lt Chains,Qn,S
Result Code121141
Result NameKappa/Lambda Ratio,S
UofM
Result LOINC48378-4
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 1
Order Code123202
Order NameFree K+L Lt Chains,Qn,S
Result Code121141
Result NameKappa/Lambda Ratio,S
UofM
Result LOINC48378-4