Gamma Zone
The immunoglobulins (IgA, IgM, IgG, IgE and IgD) are the only proteins present in the normal gamma region, but note that immunoglobulins may be found in the alpha and beta zones. If the gamma zone shows an increase (or spike), the first step in interpreting the graph is to establish if the region is narrow or wide. If it is elevated it could be elevated in a single narrow "spike-like" manner indicating monoclonal gammopathy or a broad "swell-like" manner (wide) indicating polyclonal gammopathy.
- Monoclonal Gammopathy - A narrow spike indicates a monoclonal gammopathy, also known as an "M-spike". Typically, a monoclonal gammopathy is malignant or clonal in origin, Myeloma being the most common cause of IgA and IgG spikes. chronic lymphatic leukaemia and lymphosarcoma are not uncommon and usually give rise to IgM paraproteins. Note that up to 8% of healthy geriatric patients may have a monoclonal spike. Waldenstrom's macroglobulinaemia (IgM), monoclonal gammopathy of undetermined significance (MGUS), amyloidosis, plasma cell leukemia and solitary plasmacytomas also produce an M-spike.
- Polyclonal Gammopathy - A "swell-like" elevation in the gamma zone indicates a polyclonal gammopathy, which typically indicates a non-neoplastic condition (although is not exclusive to non-neoplastic conditions). The most common causes of polyclonal hypergammaglobulinaemia detected by electrophoresis are severe infection, chronic liver disease, rheumatoid arthritis, systemic lupus erythematosus and other connective tissue diseases.
- Hypogammaglobulinaemia - This is easily identifiable as a "slump" or decrease in the gamma zone. It is normal in infants. It is found in patients with X-linked Agammaglobulinemia. IgA deficiency occurs in 1:500 of the population, as is suggested by a pallor in the gamma zone.
Lysozyme may be seen as a band cathodal to the slowest gamma in myelomonocytic leukaemia in which it is released from tumour cells. Fibrinogen from plasma samples will be seen in the fast gamma region.
Read more about this topic: Serum Protein Electrophoresis
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