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The College of American Pathologists has recently defined and introduced guidelines for clinical and laboratory evaluation of patients with monoclonal gammopathies (1)(2)(3)(4). One of these guidelines states that all patients with multiple myeloma, Waldenstrom macroglobulinemia, amyloidosis, and related disorders should be assessed for the presence of urinary monoclonal free light chains by immunofixation electrophoresis (3). Because free light chains are associated with more aggressive disease, the clinical relevance lies with the quantities of free monoclonal light chains excreted and not with the intact immunoglobulins, which also may be present in the urine (2)(5). Here we demonstrate that in some cases the intact immunoglobulins comigrate with the free light chains in immunofixation electrophoresis, and we provide a method to disclose this interference.In the diagnostic work-up of a patient suffering from multiple myeloma, we performed immunofixation electrophoresis on serum and concentrated urine using a immunofixation reagent set (Beckman) with anti-human immunoglobulin antibodies (Dako), according to the …

Disclosure of Hidden Free Light Chains by Immunosubtraction