Open AccessMonoclonal gammopathy with double M-bands: An atypical presentation on serum protein electrophoresis simulating biclonal gammopathy
Author(s) -
Kaustubh Bora,
Umesh Das,
Bhupen Barman,
Alice Abraham Ruram
Publication year - 2017
Publication title -
indian journal of pathology and microbiology/indian journal of pathology and microbiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.217
H-Index - 31
eISSN - 0974-5130
pISSN - 0377-4929
DOI - 10.4103/ijpm.ijpm_311_17
Subject(s) - serum protein electrophoresis , monoclonal gammopathy , gammopathy , multiple myeloma , monoclonal , myeloma protein , monoclonal gammopathy of undetermined significance , globulin , clone (java method) , gel electrophoresis of proteins , microbiology and biotechnology , monoclonal antibody , waldenstrom macroglobulinemia , antibody , pathology , medicine , biology , immunology , polyacrylamide gel electrophoresis , genetics , biochemistry , dna , lymphoma , enzyme
Monoclonal gammopathies, such as multiple myeloma, typically exhibit high levels of a monoclonal immunoglobulin (M-protein), produced by a clone of abnormally proliferating B-lymphocytes and/or plasma cells. The M-protein can be evaluated by serum protein electrophoresis (SPEP), which yields a single discrete band (M-band), usually in the γ-globulin region. Rarely, two M-bands appear simultaneously at different positions during SPEP - a condition known as biclonal gammopathy, which is a result of clonal expansion of two different neoplastic cell lines. Here, we describe an atypical case of IgA-λ multiple myeloma, where double M-bands (one in β- and the other in γ-globulin region) were found during SPEP simulating biclonal gammopathy, although it was monoclonal in nature. This peculiar presentation of double M-bands in monoclonal gammopathy was attributed to polymeric forms of IgA by systematic workup. Further, we discuss how true and apparent biclonality can be distinguished by inexpensive analytical techniques in resource-constrained settings.