b. Hypogammaglobulinemia (agammaglobulinemia). This is an
immunological deficiency state characterized by an abnormally low level of generally all
classes of gamma globulin. It is identified by an absent or decreased zone. In this
situation, the patient is not producing immunoglobulins in sufficient quantities to
maintain a normal immune state (Figure 5-4B).
c. Polyclonal Hypergammaglobulinemia. A broad increase in
gammaglobulins due to numerous clones of plasma cells producing a heterogeneous
group of immunoglobulins. It is identified by a diffuse increase in the gamma zone
(Figure 5-4C). This condition is exhibited in a variety of clinical disorders and therefore
is not indicative of any single disease state.
d. Monoclonal Hypergammaglobulinemia. An excess of homogeneous
immunoglobulin molecules of a single specificity following the unexplained proliferation
of a single clone of immunoglobulin-producing cells. It appears as a narrow, tall spike in
the gamma zone (Figure 5-4D). The class of immunoglobulin and increased or
detectable amounts of free light chains in the serum or urine are diagnostic as to the
clinical condition of the patient.
Section IV. IMMUNOELECTROPHORESIS (IEP)
Immunoelectrophoresis is a qualitative method that combines electrophoresis
and immunoprecipitation. Both identification and approximate quantitation may be
accomplished for individual proteins present in serum, urine, or other biological fluids.
This technique is especially useful in the identification and diagnosis of the monoclonal
gammopathies. It is a two stage procedure with the first step involving the
electrophoretic separation of the patient's serum specimen and normal control.
Following electrophoresis, specific antisera (anti-human IgG, IgM, IgA, kappa, and
lambda) are placed in troughs parallel to the line of the fractionated proteins. The
proteins and antisera diffuse in all directions with immunoprecipitin arcs forming where
specific antisera and corresponding protein antigen meet. Following a staining
procedure using a protein stain, increases or decreases of the individual's
immunoglobulins may be observed by comparing the patient's immunoprecipitin arcs to
those of the normal control.