Can lithium-heparin plasma be used for protein electrophoresis and paraprotein identification?

Ann Clin Biochem 2006;43:31-34
© 2006 Association for Clinical Biochemistry


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Original Articles

Andrew S Davison,
Simon M Darn and
Ravinder Sodi

Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool, L7 8XP, UK

Introduction: Lithium-heparin plasma is the most commonly usedsample type in many hospitals, but it has been suggested thatit is not suitable for protein electrophoresis due to the presenceof fibrinogen, which can potentially mask a paraprotein bandor be misconstrued as one. Here we aimed to demonstrate thatlithium-heparin plasma samples could be used for protein electrophoresisand paraprotein typing without or with ethanol treatment toremove the fibrinogen.

Method: A lithium-heparin sample from a patient with IgG, IgG, IgA and IgA myeloma, a non-specific polyclonal increase anda serum control were treated with ethanol prior to protein electrophoresis.Immunofixation electrophoresis was undertaken to investigatethe effect of ethanol treatment on immunoglobulin and lightchains. Nephelometry was undertaken to investigate whether ethanoltreatment affected the quantification of IgG levels. Densitometricevaluation of proteins after electrophoresis was used to studywhether ethanol treatment affected other serum proteins. Anaudit was also undertaken to ascertain the magnitude of thepotential interference from the fibrinogen band in heparinizedsamples.

Results and conclusions: Ethanol treatment significantly butincompletely removed the fibrinogen in lithium-heparin plasmasamples and did not affect the integrity of any of the proteinsinvestigated. Even without ethanol treatment, lithium-heparinplasma can be used for protein electrophoresis and paraproteinidentification as the instances of interference between fibrinogenand paraproteins was low (2.3%). In rare cases where there isuncertainty or ambiguity, immuno-fixation electrophoresis isrecommended. This report has implications in terms of reducingcosts and turn-around time as it prevents the need for requestinganother serum sample from patients. This may be one step towardsa universal sample for all tests.

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