Clinics and Departments

Laboratory Services

Lab Dept:

Urine/Stool

Test Name:

MONOCLONAL PROTEIN STUDY, URINE

General Information

Lab Order Codes:

IMU

Synonyms:

Bence Jones Urine; Heavy Chains Urine; Immunoelectrophoresis, Urine; Immunofixation, Urine; Kappa Chains Urine; Lamba Chains Urine; Light Chains Urine; Paraprotein; Special Protein Studies, Urine

CPT Codes:

84156 – Protein, total, except by refractometry; urine
84166 – Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF)
86335 – Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF)

Test Includes:

Total urine protein, reported in mg/24 hours. Electrophoresis, protein. If the protein concentration is abnormal, the following fractions, if present will be reported as a per cent of the total protein: alpha-1 globulin, alpha-2 globulin, beta-globulin, gamma-globulin.

Logistics

Test Indications:

This test is useful for detection of a monoclonal light chain in the urine of patients (Bence Jones proteinuria). It is also useful in patients with or suspected to have multiple myeloma, macroglobulinemia, amyloidosis, monoclonal gammopathies or related disorders.

Lab Testing Sections:

Urine/Stool - Sendouts

Referred to:

Mayo Medical Laboratories (MML Test #8823)

Phone Numbers:

Minneapolis:

Saint Paul:

 

612-813-6280

651-220-6550

Test Availability:

Daily, 24 hours

Turnaround Time:

1 - 3 days

Test set ups:
Protein, total urine: Daily
Protein electrophoresis: Monday through Saturday
Immunofixation: Monday through Saturday

Special Instructions:

Submit an entire 24-hour urine collection or 1 mL minimum from a random urine collection. No preservative. Refrigerate specimen during and after collection.

Note: Starting and ending times of collection are required for a timed urine collection and must be documented electronically or on the proper request form.

A 24 hour specimen is recommended but a random specimen will be tested, if received. This procedure is seldom indicated in patients <30 years of age. If serum M-protein type is known (for monoclonal protein), please indicate on request form

Specimen

Specimen Type:

Urine, timed collection

Container:

Plastic leakproof container (No preservative). Urine GUARD® collection container is preferred for a timed urine sample.

Draw Volume:

Submit an entire 24-hour urine collection

Processed Volume:

50 mL (Minimum: 25 mL) from a well mixed 24 hour urine collection
For random specimens: 1 mL urine minimum.

Collection:

For timed urine collections, empty the bladder, discard the voided sample, and note the start time. Collect all urine voided for the specified time period. At the end of the period, note the finishing time, add the last voided sample to the container by emptying the bladder. Bring the refrigerated container to the lab. Make sure all specimens submitted to the laboratory are properly labeled with the patient’s name, medical record number and date of birth.

Special Processing:

Lab staff: Measure total urine volume. Take off 50 mL (Minimum: 25 mL) aliquot urine among one 60 mL urine tube and one 13 mL urine tube or Mayo Supply T465 (6 mL tube); keep refrigerated. Patient's age and 24-hour volume are required on request form for processing. Keep specimen refrigerated. Forward promptly.

Patient Preparation:

None

Sample Rejection:

Specimens other than urine, mislabeled specimens

Interpretive

Reference Range:

Protein, Total, Urine

>or =18 yrs

<102 mg/24 hours*

Reference values have not been established for patients that are less than 18 years of age.

Electrophoresis, Urine

If protein concentration is abnormal, the following fractions, if present, will be reported as a percent of total protein.

Albumin

Alpha-1-globulin

Alpha-2-globulin

Beta-globulin

Gamma-globulin

*Reference value applies to a 24 hour collection. Specimens collected for periods other than 24 hours will be reported in concentration units.

Critical Values:

N/A

Limitations:

Monoclonal gammopathies are rarely seen in patients <30 years of age. Hemolysis may cause a discrete band on protein electrophoresis, which will be negative on immunofixation. Penicillin may split the albumin band. Radiographic agents may produce an uninterpretable pattern.

Methodology:

Dye Binding (Pyrogallol Red), Agarose Gel Electrophoresis, Immunofixation

References:

Mayo Medical Laboratories Web Page May 2011

Updates:

5/24/2011: Reference range update.



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